Comparison of Neutrophil Gelatinase-associated Lipocalin and Renal Resistive Index as Acute Kidney Injury Predictor in Critically Ill Patients at ICU H. Adam Malik Hospital Medan

Muhammad Aldi Rivai Ginting; Achsanuddin Hanafie; Bastian Lubis

doi:10.3889/oamjms.2021.7014

Authors

Muhammad Aldi Rivai Ginting Department of Anesthesia and Intensive Care Medical, Sumatera Utara University, H. Adam Malik General Hospital Medan, North Sumatra, Indonesia
Achsanuddin Hanafie Department of Anesthesia and Intensive Care Medical, Sumatera Utara University, H. Adam Malik General Hospital Medan, North Sumatra, Indonesia
Bastian Lubis Department of Anesthesia and Intensive Care Medical, Sumatera Utara University, H. Adam Malik General Hospital Medan, North Sumatra, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.7014

Keywords:

Acute kidney injury, Neutrophil gelatinase-associated lipocalin, Renal resistive index

Abstract

BACKGROUND: Acute kidney injury (AKI) is a complication found in critically ill patients. Current consensus explains that diagnosis of AKI based on increased serum creatinine and decreased urine output. Neutrophil gelatinase-associated lipocalin (NGAL) level is increased a few hours after tubular damage occurred and can predict AKI more significantly than serum creatinine. Renal resistive index (RRI) is also a good marker in predicting the early stage of AKI.

AIM: This study aimed to compare RRI and NGAL level as marker to predict incidence of AKI in critically ill patients treated in the Intensive Care Unit (ICU) at H. Adam Malik Hospital Medan.

METHODS: This was an observational prospective cohort study and conducted in ICU at H. Adam Malik Hospital Medan in April-May 2021. This study had been approved by the Ethics Committee of Faculty of Medicine, Sumatera Utara University and H. Adam Malik Hospital Medan. Inclusion criteria are critical patients aged 18–65 years with 1_st and 2_nd priority level. Consecutive sampling was used. Resistive Index (RI) measured using USG Doppler by researcher and the results confirmed by ICU supervisors, while urine NGAL level measured within 3 h after ICU admission. Plasma urea and creatinine level measured after 24h after ICU admission.

RESULTS: A total of 40 samples were collected; percentage of men and women are 66–35%, respectively (p = 0.001). There was a significant difference RI between AKI-group and non-AKI group (0.719 ± 0.060 and 0.060 ± 0.077, respectively) (p = 0.001). RI has a sensitivity of 71%, specificity of 84%, and accuracy of 87% in predicting occurrence of AKI with AUROC = 0.873. Meanwhile, NGAL has a sensitivity, specificity, and accuracy (66%, 89%, 78%, respectively) in early prediction of AKI incidence in critically ill patients.

CONCLUSION: RI value was higher in AKI group than non-AKI group. RRI has better sensitivity than NGAL in predicting incidence of AKI.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Banai A, Rozenfeld K, Levit D, Merdler I, Loewenstein I, Banai S, et al. Neutrophil gelatinase-associated lipocalin (NGAL) for the prediction of acute kidney injury in chronic kidney disease patients treated with primary percutaneous coronary intervention. IJC Heart Vasc. 2021;32:1-5. https://doi.org/10.1016/j.ijcha.2020.100695 PMid:33364336 DOI: https://doi.org/10.1016/j.ijcha.2020.100695

Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract. 2013;2013:479730. https://doi.org/10.1155/2013/479730 PMid:23573420 DOI: https://doi.org/10.1155/2013/479730

Khawaja S, Jafri L, Siddiqui I, Hashmi M, Ghani F. The utility of neutrophil gelatinase-associated Lipocalin (NGAL) as a marker of acute kidney injury (AKI) in critically Ill patients. Biomarker Res. 2019;7:4. https://doi.org/10.1186/s40364-019-0155-1 PMid:30834123 DOI: https://doi.org/10.1186/s40364-019-0155-1

Li H, Yu Z, Gan L, Peng L, Zhou Q. Serum NGAL and FGF23 may have certain value in early diagnosis of CIN. Renal Failure. 2018;40(1):547-53. https://doi.org/10.1080/0886022X.2018.1487860 PMid:30278796 DOI: https://doi.org/10.1080/0886022X.2018.1487860

Mahadevaiah M, Thimmaiah M, Yerramsetty V, Kumar J, Kumar R. Diagnostic relevance of neutrophil gelatinase associated lipocalin in early detection of acute kidney injury. J Emerg Pract Trauma. 2021;7(2):88-92. DOI: https://doi.org/10.34172/jept.2020.38

Mulier J, Rozemeijer S, Röttgering JG, Spoelstra-de Man AM, Elbers PW, Tuinman PR, et al. Renal resistive index as an early predictor and discriminator of acute kidney injury in critically ill patients; a prospective observational cohort study. PLoS One. 2018;13(6):1-18. https://doi.org/10.1371/journal.pone.0197967 PMid:29889830 DOI: https://doi.org/10.1371/journal.pone.0197967

Muthukrishnan K, Parida S, Barathim S, Badhe A, Mishra S. Doppler resistive index to reflect risk of acute kidney injury after major abdominal surgery: A prospective observational trial. Indian J Anaesth. 2019;63(7):551-7. https://doi.org/10.4103/ija.IJA_189_19 PMid:31391618 DOI: https://doi.org/10.4103/ija.IJA_189_19

Shang W, Wang Z. The update of NGAL in acute kidney injury. Curr Protein Peptide Sci. 2017;17:1211-7. https://doi.org/10.2174/1389203717666160909125004 PMid:27634444 DOI: https://doi.org/10.2174/1389203717666160909125004