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Performance of plasma measurement of neutrophil gelatinase-associated lipocalin as a biomarker of bacterial infections in the intensive care unit
Karolinska Inst, Dept Physiol & Pharmacol, S-17177 Stockholm, Sweden.
Karolinska Inst, Dept Med, S-17177 Stockholm, Sweden.
Karolinska Inst, Dept Physiol & Pharmacol, S-17177 Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
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2019 (English)In: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 53, p. 264-270Article in journal (Refereed) Published
Abstract [en]

Purpose: To assess the value of dimeric neutrophil-gelatinase associated lipocalin (NGAL) as an early marker of bacterial infection and its response to antibiotic therapy in intensive care unit (ICU) patients.

Materials & methods: We measured daily plasma dNGAL in 198 patients admitted to a mixed ICU. Likelihood of infection was determined with International Sepsis Forum criteria. Wemeasured dNGAL in 145 healthy controls to establish normal values.

Results: ICU patients had higher dNGAL than healthy controls. A suspected or confirmed infection was independently associated with 90% (95% CI 15-215%) higher dNGAL than absence of infection. We observed no association between acute kidney injury and dNGAL. Diagnostic accuracy at antibiotic treatment initiation, assessed with area under the receiver-operating characteristics curve (AUC-ROC), for dNGAL was 0.70 (95% CI 0.60-0.79). AUC-ROC for dNGAL 24 h before antibiotic treatment initiation was 0.54 (95% CI 0.41-0.66). The mean (95% CI) change of dNGAL in the first 2 days after appropriate antibiotic therapy initiation was -31 (-49,-13)%.

Conclusions: In our cohort of ICU patients, plasma dNGAL was associated with presence of bacterial infections independent of AKI but it performed poor as a predictor of infections. Following antibiotic therapy, dNGAL markedly decreased-supporting further exploration of dNGAL-guided antibiotic de-escalation.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC , 2019. Vol. 53, p. 264-270
National Category
Anesthesiology and Intensive Care Infectious Medicine
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URN: urn:nbn:se:uu:diva-392117DOI: 10.1016/j.jcrc.2019.07.001ISI: 000478566600043PubMedID: 31301642OAI: oai:DiVA.org:uu-392117DiVA, id: diva2:1348959
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Stockholm County CouncilAvailable from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-09-06Bibliographically approved

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