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Engström J, Koozi H, Didriksson I, Larsson A, Friberg H, Frigyesi A, Spångfors M. Plasma neutrophil gelatinase-associated lipocalin independently predicts dialysis need and mortality in critical COVID-19. Sci Rep 2024; 14:6695. [PMID: 38509165 PMCID: PMC10954663 DOI: 10.1038/s41598-024-57409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a novel kidney injury and inflammation biomarker. We investigated whether NGAL could be used to predict continuous renal replacement therapy (CRRT) and mortality in critical coronavirus disease 2019 (COVID-19). This prospective multicenter cohort study included adult COVID-19 patients in six intensive care units (ICUs) in Sweden between May 11, 2020 and May 10, 2021. Blood was sampled at admission, days two and seven in the ICU. The samples were batch analyzed for NGAL, creatinine, and cystatin c after the end of the study period. Initiation of CRRT and 90-day survival were used as dependent variables in regression models. Of 498 included patients, 494 were analyzed regarding CRRT and 399 were analyzed regarding survival. Seventy patients received CRRT and 154 patients did not survive past 90 days. NGAL, in combination with creatinine and cystatin c, predicted the subsequent initiation of CRRT with an area under the curve (AUC) of 0.95. For mortality, NGAL, in combination with age and sex, had an AUC of 0.83. In conclusion, NGAL is a valuable biomarker for predicting subsequent initiation of CRRT and 90-day mortality in critical COVID-19. NGAL should be considered when developing future clinical scoring systems.
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Affiliation(s)
- Jonas Engström
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden.
- Department of Anesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, 291 85, Sweden.
| | - Hazem Koozi
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Anesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, 291 85, Sweden
| | - Ingrid Didriksson
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, 205 02, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, 751 05, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, 205 02, Sweden
| | - Attila Frigyesi
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, 221 85, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences, Lund University, Anesthesiology and Intensive Care, Lund, 221 00, Sweden
- Department of Anesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, 291 85, Sweden
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Kaushal A, Chouhan RS, Bindra A, Gaikwad S, Subbiah V. Measurement of Neutrophil Gelatinase-Associated Lipocalin (Ngal) Following Neuroradiological Procedure/s in Patients with Aneurysmal Subarachnoid Hemorrhage: A Preliminary Study. Neurol India 2023; 71:1187-1191. [PMID: 38174456 DOI: 10.4103/0028-3886.391401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Radiocontrast administration during interventional neuroradiology (INR) procedures for aneurysmal subarachnoid haemorrhage (aSAH) can add to renal insult. Serum creatinine (sCr) is a conventional marker of acute kidney injury (AKI). Serum neutrophil gelatinase-associated lipocalin (sNGAL) is a novel marker which is increasingly used to predict renal injury in susceptible patients. Objectives The primary aim of this study was to evaluate correlation between serum neutrophil gelatinase-associated lipocalin (NGAL) and sCr in aSAH patients undergoing therapeutic or diagnostic INR procedures. The secondary aim was to find the incidence of contrast-induced AKI and hemodynamic complications during the study period. Material and Methods All consenting aSAH patients (18-60 years, Modified Hunt and Hess grade 1-4) posted for INR procedures during the study time were included. Patients with history of chronic renal disease, recent contrast exposure, or renal insufficiency were excluded. Blood samples for sCr and sNGAL were obtained preprocedure and then at 1, 6, 24, and 48 h after contrast administration. Hourly urine output was noted. AKI was defined by KDIGO guidelines. Statistical Analysis Used Repeated measurement analysis of variance, Posthoc Bonferroni test and Pearson correlation coefficient test. Results Fifty patients, mean age 47.34 ± 9.31 years, were enrolled for the study. Majority (48; 96%) were Hunt and Hess (H and H) grade I-III. The mean volume of contrast administered was 123.2 ± 53.08 mL. The mean sNGAL and sCr values at pre-op, 1, 6, 24, and 48 h were 124.99 ± 64.58, 148.40 ± 77.90, 147.33 ± 76.00, 125.49 ± 64.44, and 116.38 ± 61.79 ng/mL and 0.629 ± 0.23, 0.624 ± 0.22, 0.612 ± 0.21, 0.632 ± 0.19, and 0.577 ± 0.22 mg/dL, respectively. There was a correlation in sCr and sNGAL value (P < 0.001) at all study time points. However, no specific pattern was seen. No patient developed any AKI or hemodynamic complications in first 48 h. Conclusions There is a correlation between serum NGAL and sCr at individual time points. NGAL may represent a sensitive early biomarker of renal impairment after INR Procedures. There was no incidence of AKI after contrast administration in aSAH patients without predisposing renal risk factors.
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Affiliation(s)
- Ashutosh Kaushal
- Department of Anaesthesiology, All India Institute of Medical Sciences (A.I.I.M.S), Bhopal, Madhya Pradesh, India
| | - Rajendra S Chouhan
- Department of Neuroanaesthesia and Critical Care, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - Ashish Bindra
- Department of Neuroanaesthesia and Critical Care, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - Shailesh Gaikwad
- Department of Neuroimaging & Interventional Neuroradiology, A.I.I.M.S, New Delhi, India
| | - Vivekanandhan Subbiah
- Department of Clinical Biochemistry, All India Institute of Medical Sciences (A.I.I.M.S), Rishikesh, Uttarakhand, India
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Jarczak D, Kluge S, Nierhaus A. Sepsis-Pathophysiology and Therapeutic Concepts. Front Med (Lausanne) 2021; 8:628302. [PMID: 34055825 PMCID: PMC8160230 DOI: 10.3389/fmed.2021.628302] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/09/2021] [Indexed: 12/12/2022] Open
Abstract
Sepsis is a life-threatening condition and a global disease burden. Today, the heterogeneous syndrome is defined as severe organ dysfunction caused by a dysregulated host response to infection, with renewed emphasis on immune pathophysiology. Despite all efforts of experimental and clinical research during the last three decades, the ability to positively influence course and outcome of the syndrome remains limited. Evidence-based therapy still consists of basic causal and supportive measures, while adjuvant interventions such as blood purification or targeted immunotherapy largely remain without proof of effectiveness so far. With this review, we aim to provide an overview of sepsis immune pathophysiology, to update the choice of therapeutic approaches targeting different immunological mechanisms in the course of sepsis and septic shock, and to call for a paradigm shift from the pathogen to the host response as a potentially more promising angle.
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Affiliation(s)
- Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ma S, Zhao ML, Wang K, Yue YF, Sun RQ, Zhang RM, Wang SF, Sun G, Xie HQ, Yu Y, Wang L, Zhang WP, Wang SJ, Zhu HC, Wang L. Association of Ang-2, vWF, and EVLWI with risk of mortality in sepsis patients with concomitant ARDS: A retrospective study. J Formos Med Assoc 2019; 119:950-956. [PMID: 31822372 DOI: 10.1016/j.jfma.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 07/18/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/PURPOSE This study aimed to determine the potential effects of angiopoietin-2 (Ang-2), von Willebrand factor (vWF), and extravascular lung water index (EVLWI) on the risk of mortality in sepsis patients with concomitant acute respiratory distress syndrome (ARDS). METHODS This retrospective study recruited 41 sepsis patients with concomitant ARDS from January 2015 to June 2018. Data of Ang-2 and vWF levels, EVLWI, and sequential organ failure assessment scores were collected at 0, 24, and 48 h after admission to the hospital. RESULTS The length of intensive care unit stay (P = 0.041) and Acute Physiology and Chronic Health Evaluation-2 (APACHE II) score (P = 0.003) were associated with the risk of mortality. Furthermore, increased Ang-2 levels and EVLWI at 24 h and 48 h were associated with an increased risk of mortality. Moreover, the APACHE II score at hospital admission significantly predicted the risk of mortality (area under the curve [AUC], 0.834; 95% confidence interval [CI], 0.665-0.983). Finally, the models containing a combination of Ang-2 level and EVLWI at 24 h (AUC, 0.908; 95% CI, 0.774-0.996) and Ang-2 level and EVLWI at 48 h (AUC, 0.981; 95% CI, 0.817-1.000) had high diagnostic values for predicting risk of mortality. CONCLUSION The study findings indicate that Ang-2 levels and EVLWI at 24 h and 48 h after admission are significantly associated with the risk of mortality.
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Affiliation(s)
- Shuang Ma
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Mei-Ling Zhao
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Kai Wang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China.
| | - Yi-Feng Yue
- Department of Anesthesiology, Zibo Central Hospital, Zibo, 255000, Shandong Province, China.
| | - Rong-Qing Sun
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Ru-Min Zhang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Shi-Fu Wang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Guang Sun
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Hong-Qiang Xie
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Yong Yu
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Lin Wang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Wei-Ping Zhang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Shou-Jun Wang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Hong-Chang Zhu
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
| | - Lei Wang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, 255000, Shandong Province, China
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Moon JM, Chun BJ, Shin MH, Cho YS. Predictive value of plasma neutrophil gelatinase-associated lipocalin in acute charcoal-burning carbon monoxide poisoning. Hum Exp Toxicol 2019; 38:877-887. [DOI: 10.1177/0960327119851259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to assess the feasibility of using the plasma neutrophil gelatinase-associated lipocalin (NGAL) level at the time of presentation in the emergency department (ED) to predict acute kidney injury (AKI) and the long-term neurological outcomes of acute charcoal-burning carbon monoxide (CO) poisoning. This retrospective study included 260 patients who suffered acute charcoal-burning CO poisoning. The median plasma NGAL concentration at the time of presentation in the ED after acute charcoal-burning CO poisoning was 78 (54–115) ng/ml. The NGAL level was an independent predictor of AKI development and could be used to stratify the severity of AKI. However, the area under the receiver operating characteristic curve (AUC) of the predictive model for AKI that included both the plasma NGAL level and clinical parameters was comparable to that of the predictive model including only the clinical parameters. The plasma NGAL level at the time of presentation in the ED was an independent factor predicting long-term neurological outcomes in patients who did not develop AKI. In these patients, the plasma NGAL level significantly improved the predictive accuracy of the model when used in combination with clinical parameters. In contrast, the plasma NGAL level was not associated with long-term neurological outcomes in patients who developed AKI. Measurement of the plasma NGAL level at the time ED presentation might improve the prediction of long-term neurological outcomes in patients who do not develop AKI after acute charcoal-burning CO poisoning. However, it might not offer additional benefit for AKI prediction compared to previously used markers.
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Affiliation(s)
- JM Moon
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - BJ Chun
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - MH Shin
- Department of Preventive medicine, Chonnam National University Medical School, Hwasun, South Korea
| | - YS Cho
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
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Strazzulla A, Coppolino G, Barreca GS, Gentile I, Rivoli L, Postorino MC, Mazzitelli M, Greco G, Costa C, Pisani V, Marascio N, Simeoni M, Focà A, Fuiano G, Foti D, Gulletta E, Torti C. Evolution of glomerular filtration rates and neutrophil gelatinase-associated lipocalin during treatment with direct acting antivirals. Clin Mol Hepatol 2018; 24:151-162. [PMID: 29684978 PMCID: PMC6038935 DOI: 10.3350/cmh.2017.0059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Correct renal function evaluation is based on estimated glomerular filtration rates (eGFR) and complementary renal damage biomarkers, such as neutrophil gelatinase associated lipocalin (NGAL). The aim of this study was to evaluate eGFR and NGAL modifications and renal impairment during treatment with a direct acting antiviral (DAA) for chronic hepatitis C virus (HCV) infection. Methods A retrospective cohort study evaluated eGFR modification during treatment with DAA. Subgroup analysis on serum NGAL was conducted in those receiving sofosbuvir/ledipasvir, with complete follow-up until week 12 after the end of treatment (FU-12). Results In the 102 enrolled patients, eGFR reduction was observed (from 86.22 mL/min at baseline to 84.43 mL/min at FU-12, P=0.049). Mean NGAL increased in 18 patients (from 121.89 ng/mL at baseline to 204.13 ng/mL at FU-12, P=0.014). At FU-12, 38.8% (7/18) of patients had a plasmatic NGAL value higher than the normal range (36-203 ng/mL) compared with 11.1% (2/18) at baseline (χ2 =3,704; P=0.054). In contrast, eGFR did not change significantly over the follow-up in this subgroup. Conclusions In conclusion, compared to a negligible eGFR decline observed in the entire cohort analyzed, a significant NGAL increase was observed after HCV treatment with DAA in a small subgroup. This could reflect tubular damage during DAA treatment rather than glomerular injury.
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Affiliation(s)
- Alessio Strazzulla
- Division of Infectious Diseases, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Coppolino
- Division of Nephrology and Dialysis, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Giorgio Settimo Barreca
- Division of Microbiology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Innocenza Gentile
- Division of Clinical Pathology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Laura Rivoli
- Division of Nephrology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Concetta Postorino
- Division of Infectious Diseases, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Mazzitelli
- Division of Infectious Diseases, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Greco
- Division of Infectious Diseases, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Chiara Costa
- Division of Infectious Diseases, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Vincenzo Pisani
- Division of Infectious Diseases, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Nadia Marascio
- Division of Microbiology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Mariadelina Simeoni
- Division of Nephrology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alfredo Focà
- Division of Microbiology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giorgio Fuiano
- Division of Nephrology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Daniela Foti
- Division of Clinical Pathology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Elio Gulletta
- Division of Clinical Pathology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Carlo Torti
- Division of Infectious Diseases, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Ralib AM, Nanyan S, Ramly NF, Har LC, Cheng TC, Mat Nor MB. Acute Kidney Injury in Malaysian Intensive Care Setting: Incidences, Risk Factors, and Outcome. Indian J Crit Care Med 2018; 22:831-835. [PMID: 30662220 PMCID: PMC6311985 DOI: 10.4103/ijccm.ijccm_193_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Acute kidney injury (AKI) is common in the intensive care unit (ICU) with a high risk of morbidity and mortality. The high incidence of AKI in our population may be attributed to sepsis. We investigated the incidence, risk factors, and outcome of AKI in four tertiary Malaysian ICUs. We also evaluated its association with sepsis. Materials and Methods: This retrospective cohort study extracted de-identified data from the Malaysian Registry of Intensive Care in four Malaysian tertiary ICUs between January 2010 and December 2014. The study was registered under the NMRR and approved by the ethics committee. AKI was defined as twice the baseline creatinine or urine output <0.5 ml/kg/h for 12 h. Results: Of 26,663 patients, 24.2% had AKI within 24 h of admission. Patients with AKI were older and had higher severity of illness compared to those without AKI. AKI patients had a longer duration of mechanical ventilation, length of ICU, and hospital stay. Age, Simplified Acute Physiological II Score, and the presence of sepsis and preexisting hypertension, chronic cardiovascular disease independently associated with AKI. About 32.3% had sepsis. Patients with both AKI and sepsis had the highest risk of mortality (relative risk 3.43 [3.34–3.53]). Conclusions: AKI is common in our ICU, with higher morbidity and mortality. Independent risk factors of AKI include age, the severity of illness, sepsis and preexisting hypertension, and chronic cardiovascular disease. AKI independently contributes to mortality. The presence of AKI and sepsis increased the risk of mortality by three times.
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Affiliation(s)
- Azrina Md Ralib
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Suhaila Nanyan
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nur Fariza Ramly
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Lim Chew Har
- Department of Anaesthesiology and Intensive Care, Hospital Pulau Pinang, Penang, Malaysia
| | - Tan Cheng Cheng
- Department of Anaesthesiology and Intensive Care, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Mohd Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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