Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 52-59.e1 , July 2010

The Diagnostic Accuracy of Plasma Neutrophil Gelatinase–Associated Lipocalin in the Prediction of Acute Kidney Injury in Emergency Department Patients With Suspected Sepsis

Presented at Society for Academic Emergency Medicine annual meeting, May 2009, New Orleans, LA.

  • Nathan I. Shapiro, MD, MPH

      Affiliations

    • Beth Israel Deaconess Medical Center, Boston, MA
    • Corresponding Author InformationAddress for correspondence: Nathan I. Shapiro, MD, MPH, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, CC2-W, Boston, MA 02116617-754–2323, fax 617-754-2350
    • ,
  • Stephen Trzeciak, MD, MPH

      Affiliations

    • Cooper University Hospital, Camden, NJ
    • ,
  • Judd E. Hollander, MD

      Affiliations

    • University of Pennsylvania, Philadelphia, PA
    • ,
  • Robert Birkhahn, MD

      Affiliations

    • New York Methodist Hospital, Brooklyn, NY
    • ,
  • Ronny Otero, MD

      Affiliations

    • Henry Ford Health System, Detroit, MI
    • ,
  • Tiffany M. Osborn, MD

      Affiliations

    • University of Virginia, Charlottesville, VA
    • ,
  • Eugene Moretti, MD, MHSc

      Affiliations

    • Duke University Medical Center, Durham, NC
    • ,
  • H. Bryant Nguyen, MD

      Affiliations

    • Loma Linda University Medical Center, Loma Linda, CA
    • ,
  • Kyle Gunnerson, MD

      Affiliations

    • Virginia Commonwealth University, Richmond, VA
    • ,
  • David Milzman, MD

      Affiliations

    • Georgetown University Medical School/Washington Hospital Center, Washington, DC
    • ,
  • David F. Gaieski, MD

      Affiliations

    • University of Pennsylvania, Philadelphia, PA
    • ,
  • Munish Goyal, MD

      Affiliations

    • University of Pennsylvania, Philadelphia, PA
    • ,
  • Charles B. Cairns, MD

      Affiliations

    • Duke University Medical Center, Durham, NC
    • ,
  • Kenneth Kupfer, PhD

      Affiliations

    • Biosite Incorporated, San Diego, CA
    • ,
  • Seok-Won Lee, PhD

      Affiliations

    • Biosite Incorporated, San Diego, CA
    • ,
  • Emanuel P. Rivers, MD, MPH

      Affiliations

    • Henry Ford Health System, Detroit, MI

Received 11 August 2009 ,Revised 30 January 2010 ,Accepted 5 February 2010.

References 

  1. Supavekin S, Zhang W, Kucherlapati R, et al. Differential gene expression following early renal ischemia/reperfusion. Kidney Int. 2003;63:1714–1724
  2. Mishra J, Mori K, Ma Q, et al. Neutrophil gelatinase-associated lipocalin: a novel early urinary biomarker for cisplatin nephrotoxicity. Am J Nephrol. 2004;24:307–315
  3. Mori K, Rapoport D, Drexler IR, et al. Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest. 2005;115:610–621
  4. Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005;365:1231–1238
  5. Wagener G, Jan M, Kim M, et al. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology. 2006;105:485–491
  6. Dent CL, Ma Q, Dastrala S, et al. Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care. 2007;11:R127
  7. Wagener G, Gubitosa G, Wang S, et al. Urinary neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery. Am J Kidney Dis. 2008;52:425–433
  8. Haase-Fielitz A, Bellomo R, Deverejan P, et al. Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery—a prospective cohort study. Crit Care Med. 2009;37:553–560
  9. Bagshaw SM, Uchino S, Bellmo R, et al. Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care. 2009;24:129–140
  10. Shapiro NI, Trzeciak S, Hollander JE, et al. A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis. Crit Care Med. 2009;37:96–104
  11. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–874
  12. Bellomo R, Kellum JA, Ronco C. Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med. 2007;33:409–413
  13. Kellum JA, Bellomo R, Ronco C. Classification of acute kidney injury using RIFLE: what's the purpose?. Crit Care Med. 2007;35:1983–1984
  14. Kellum JA, Bellomo R, Ronco C. The concept of acute kidney injury and the RIFLE criteria. Contrib Nephrol. 2007;156:10–16
  15. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36
  16. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148:839–843
  17. Hoste EA, Kellum JA. Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care. 2006;12:531–537
  18. Wheeler DS, Devarajan P, Ma Q, et al. Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med. 2008;36:1297–1303
  19. Malyszko JS, Mlyszko J, Hryszko T, et al. Markers of endothelial damage in patients on hemodialysis and hemodiafiltration. J Nephrol. 2006;19:150–154
  20. Nickolas TL, O'Rourke MJ, Yang J, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med. 2008;148:810–819

 Supervising editors: Alan E. Jones, MD; Michael L. Callaham, MD

 Author contributions: NIS and ST conceived of the secondary analysis and drafted the primary article. All authors worked on data collection, reviewed the article, and had the opportunity to give critical input. NIS takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was funded by Biosite Diagnostics. Dr. Shapiro has consulted for and received honoraria from Eli Lilly, and received grant support from Abbott Laboratories, Biosite, and Inverness Medical Innovations. Dr. Trzeciak receives research support from Eli Lilly, Biosite, NovaNordisk, the American Heart Association, and the Shock Society. Dr. Hollander has received honoraria and/or consultant fees from Sanofi- Aventis, GlaxoSmithKline, PDL BioPharma, Bristol- Myers Squibb Medical, Genentech, Astra-Zeneca, Baxter, The Medicines Company, Ot suka America, Molecular Insights, Biosite, Scios, Ethicon, and Schering-Plough, as well as grant support from Inverness Medical, Biosite, Siemens, Sanofi-Aventis, and Abbott Laboratories. Drs. Birkhahn, Osborn, Cairns, and Gunnerson have received grant support from Biosite. Dr. Otero is the recipient of research grants. Dr. Nguyen has consulted for and received honoraria from Eli Lilly and Edwards Lifesciences, and received grant support from Edwards Lifesciences and Biosite. Dr. Gaieski has received research grants from Biosite/Inverness Medical. Dr. Goyal has received honoraria from Edwards Lifesciences. Dr. Rivers has received research support from Biosite, Edwards Lifesciences, Hutchinson Technologies and the National Institute of Allergy and Infectious Disease; honoraria from Biosite, Edwards Life- sciences, Elan Pharmaceuticals, Takeda, and Aggenix; and consultant fees from Eli Lilly, Chiron, AstraZeneca, and Ferring Pharmaceuticals. Drs. Moretti, Ngo, and Milzman have not disclosed any potential conflict of interest.

 Publication date: Available online April 3, 2010.

 Reprints not available from the authors.

 Please see page 53 for the Editor's Capsule Summary of this article.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

PII: S0196-0644(10)00144-7

doi: 10.1016/j.annemergmed.2010.02.010

Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 52-59.e1 , July 2010

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