Assessment of serum acylated ghrelin in children and adolescents with chronic liver diseases: relation to nutritional status.

Because ghrelin is one of the key hormones in regulating feeding behavior and caloric status, it was suggested that ghrelin behavior might be closely associated with malnutrition state of patients with chronic liver disease (CLD). Thus, we aimed to assess serum ghrelin levels in children with CLD and its relation to anthropometric parameters and severity of CLD. Forty CLD patients were studied in comparison to 40 controls. All subjects were subjected to history, anthropometric, and laboratory assessment of liver functions and serum acylated ghrelin. Ghrelin was higher in patients than controls being higher with progress of Child's grade and with deterioration of liver functions. Hyperghrelinemia was detected in 62.5% of cases. Ghrelin correlated negatively with body mass index standard deviation score (BMISDS (r = -0.95, P < 0.001)), triceps skin fold thickness (TSFT (r = -0.88, P < 0.001)), and subscapular skin fold thickness (SSFT (r = 0.83, P < 0.001)) percentiles. In conclusion, hyperghrelinemia may represent a compensatory mechanism trying to overcome malnutrition state complicating CLD and can be used as a parameter for early detection and assessment of the severity of malnutrition in children with CLD.

Serum neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in asphyxiated neonates.

OBJECTIVE: To determine the clinical utility of serum neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in asphyxiated neonates with hypoxic ischemic encephalopathy (HIE). DESIGN: Cohort study. SETTINGS: National Intensive Care Unit of Maternity Hospital, Ain Shams University, Cairo, Egypt. PATIENTS: The study included 30 term asphyxiated neonates (8 with mild, 13 with moderate and 9 with severe HIE) and 20 control neonates. INTERVENTION: Serum NGAL level was measured within 6 hours after birth using an enzyme linked immunosorbent assay. MAIN OUTCOME MEASURES: Patients were subsequently discriminated into AKI (n=12) and no-AKI (n=18) groups. RESULTS: The median (Interquartile range) serum NGAL concentration was 95.0 (70.75-180.00) ng/mL in asphyxiated neonates, and 39.75 (6.0-48.0) ng/mL in control neonates; (P<0.001). Serum NGAL correlated with HIE severity: mean (SD) was 65.50 (3.77) ng/mL in infants with mild HIE, 115.07 (45.83) ng/mL in infants with moderate HIE and 229.66 (79.50) ng/mL in infants with severe HIE; (P<0.01). The median (Interquartiles) serum NGAL level was 182.50 (166.25-301.75) ng/mL in patients with AKI, 74.00 (66.00-78.75) ng/mL in those without AKI; (P<0.001). A cutoff value 157 ng/mL for serum NGAL could detect AKI in asphyxiated neonates with a sensitivity of 83.3% and a specificity of 94.4%. CONCLUSION: Elevated serum NGAL measured within 6 hours after birth reliably indicates acute kidney injury in asphyxiated neonates.

Serum neutrophil gelatinase-associated lipocalin as a predictor of acute kidney injury in critically-ill neonates.

Early detection of evolving Acute Kidney Injury (AKI) in critically ill neonates can lead to better preventive and therapeutic interventions. Neutrophil Gelatinase-associated Lipocalin (NGAL) is a promising biomarker of AKI, which was also shown to increase in inflammation. The objective of this study was to assess the utility of serum NGAL (sNGAL) as an early marker of evolving AKI in critically-ill neonates with and without sepsis. sNGAL levels were estimated in 60 critically-ill neonates at the time of admission to Neonatal Intensive Care Unit (NICU), in comparison to 20 healthy matched control. Patients were categorized as sepsis (n = 35) and no-sepsis (n = 25) subgroups on basis of clinical and laboratory criteria. They were subsequently discriminated according to creatinine and urine output criteria of the Acute Kidney Injury Network (AKIN), into AKI (n = 34) and no-AKI (n = 26) subgroups, sNGAL levels were significantly higher in the patient group as compared to control (132.7 +/- 67.8 vs. 55 +/- 10.3 ng mL(-1), p = 0.0001). Elevated levels were comparable between sepsis and no-sepsis groups (130.1 +/- 69.4 vs. 136.5 +/- 66.6 ng mL(-1), p = 0.7) and they positively correlated with 48-hour post-admission serum creatinine (p = 0.0001). Patients of AKI group had significantly higher sNGAL than those of no-AKI group (176.2 +/- 55.9 vs. 75.9 +/- 28.3 ng mL(-1), p = 0.0001). A cut-off value for sNGAL of 117.5 ng mL(-1), was predictive of AKI with a sensitivity of 82% and a specificity of 88.5%. It could be speculated that measurement of serum NGAL can serve as a clinically useful marker for early prediction of evolving AKI in critically-ill neonates with and without sepsis.