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Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients
Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia.;Karolinska Inst, Sect Anesthesia & Intens Care Med, Dept Physiol & Pharmacol, Stockholm, Sweden..
Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia.;Monash Univ, Sch Prevent Med & Publ Hlth, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic 3004, Australia..
Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia..
Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia.;Deakin Univ, Sch Nursing & Midwifery, Melbourne, Vic 3004, Australia..
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2015 (English)In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 81, no 11, 1192-1200 p.Article in journal (Refereed) PublishedText
Abstract [en]

Background. Labile iron is important in the pathogenesis of acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin control iron metabolism and are upregulated during renal stress. However, higher levels of urinary NGAL are associated with AKI severity whereas higher urinary hepcidin levels are associated with absence of AKI. We aimed to investigate the value of combining both biomarkers to estimate the severity and progression of AKI in intensive care unit (ICU) patients. Methods. Urinary NGAL and hepcidin were quantified within 48 hours of ICU admission in patients with the systemic inflammatory response syndrome and early kidney dysfunction (oliguria for >= 2 hours and/or a 25 mu mol/L creatinine rise from baseline). Diagnostic and prognostic characteristics were assessed by logistic regression and receiver operating characteristics (ROC) analysis. Results. Of 102 patients, 26 had mild AKI and 28 patients had severe AKI on admission. Sepsis (21%), cardiac surgery (17%) and liver failure (9%) were primary admission diagnoses. NGAL increased (P=0.03) whereas hepcidin decreased (P=0.01) with increasing AKI severity. The value of NGAL/hepcidin ratio to detect severe AKI was higher than when NGAL and hepcidin were used individually and persisted after adjusting for potential confounders (adjusted OR 2.40, 95% CI 1.20-4.78). The ROC areas for predicting worsening AKI were 0.50, 0.52 and 0.48 for NGAL, 1/hepcidin and the NGAL/hepcidin ratio. Conclusion. The NGAL/hepcidin ratio is more strongly associated with severe AKI than the single biomarkers alone. NGAL and hepcidin, alone or combined as a ratio, were unable to predict progressive AKI in this selected ICU cohort.

Place, publisher, year, edition, pages
2015. Vol. 81, no 11, 1192-1200 p.
Keyword [en]
LCN2 protein, human, Hepcidins, Acute Kidney Injury, Oliguria, Iron
National Category
Anesthesiology and Intensive Care
URN: urn:nbn:se:uu:diva-275881ISI: 000367565200008PubMedID: 25479470OAI: oai:DiVA.org:uu-275881DiVA: diva2:902242
Available from: 2016-02-10 Created: 2016-02-08 Last updated: 2016-02-10Bibliographically approved

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