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Title: The nature and discriminatory value of urinary neutrophil gelatinase-associated lipocalin in critically ill patients at risk of acute kidney injury.
Austin Authors: Glassford, Neil J;Schneider, Antoine G;Xu, Shengyuan;Eastwood, Glenn M ;Young, Helen ;Peck, Leah ;Venge, Per;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Melbourne, VIC, 3084, Australia
Issue Date: 6-Aug-2013
Publication information: Intensive Care Medicine 2013; 39(10): 1714-24
Abstract: Different molecular forms of urinary neutrophil gelatinase-associated lipocalin (NGAL) have recently been discovered. We aimed to explore the nature, source and discriminatory value of urinary NGAL in intensive care unit (ICU) patients.We simultaneously measured plasma NGAL (pNGAL), urinary NGAL (uNGAL), and estimated monomeric and homodimeric uNGAL contribution using Western blotting-validated enzyme-linked immunosorbent assays [uNGAL(E1) and uNGAL(E2)] and their calculated ratio in 102 patients with the systemic inflammatory response syndrome and oliguria, and/or a creatinine rise of >25 μmol/L.Bland-Altman analysis demonstrated that, despite correlating well (r = 0.988), uNGAL and uNGAL(E1) were clinically distinct, lacking both accuracy and precision (bias: 266.23; 95% CI 82.03-450.44 ng/mg creatinine; limits of agreement: -1,573.86 to 2,106.32 ng/mg creatinine). At best, urinary forms of NGAL are fair (area under the receiver operating characteristic [AUROC] ≤0.799) predictors of renal or patient outcome; most perform significantly worse. The 44 patients with a primarily monomeric source of uNGAL had higher pNGAL (118.5 ng/ml vs. 72.5 ng/ml; p < 0.001), remaining significant following Bonferroni correction.uNGAL is not a useful predictor of outcome in this ICU population. uNGAL patterns may predict distinct clinical phenotypes. The nature and source of uNGAL are complex and challenge the utility of NGAL as a uniform biomarker.
Gov't Doc #: 23917325
DOI: 10.1007/s00134-013-3040-7
Type: Journal Article
Subjects: APACHE
Acute Kidney Injury.diagnosis.etiology.urine
Acute-Phase Proteins.urine
Area Under Curve
Biological Markers.blood.urine
Blotting, Western
Critical Illness
Intensive Care Units.statistics & numerical data
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Assessment.methods
Systemic Inflammatory Response Syndrome.complications.diagnosis
Appears in Collections:Journal articles

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