The role of urinary NGAL as diagnosis and prognosis predictor of acute kidney injury associated with sepsis in patients admitted to the emergency room

Abstract

Acute kidney injury (AKI) associated with sepsis remains a major challenge in intensive care because of its common occurrence, high costs of treatment and the unacceptably high mortality. The measure of creatinine is the most widely used for diagnosis of AKI, however, it is known that it is not the ideal marker of renal damage. The difficulty in identifying the AKI is not restricted to diagnosis but also to the difficulty in predicting evolution of AKI patients. Thus, studies are needed to identify early markers of diagnosis and prognosis of AKI associated with sepsis. NGAL is a promising biomarker serum and urine for the early AKI detection. Many studies have validated the NGAL as a predictor specific, sensitive and early AKI after cardiac surgery, contrast administration and in intensive care units, but little is known about this association in septic patients admitted to the emergency room. This study aims to assess the effectiveness of urinary NGAL (u) as diagnosis and prognosis predictor of AKI associated with sepsis in patients admitted to the emergency room. Septic patients admitted to the emergency room will be studied prospectivelly during the period 1st December 2012 to 30 rd november 2013. It will be estimated a population of 360 patients during the study. For each patient will be performed protocol with clinical and laboratory data and these data will be obtained by the same researcher, since patients admission to the emergency room until patients outcome (hospital discharge or death). Assessment of renal function will be performed daily by dosage of serum creatinine and urine output. Dosage of uNGAL will be performed at the following times: first 24h, between 24 and 48 hours after admission, on the day of AKI diagnosis by AKIN criteria, on the day of dialysis start and finish. Results will be presented using descriptive statistics and different statistical tests will be used according to the study objectives. Diagnostic characteristics of uNGAL in predicting AKI will assessed by calculation of the area under the receiver operating characteristic curve (AUC-ROC). AUC-ROC analysis will be performed by comparing AKI and non-AKI patients. Survival curves using Kaplan Meyer also will be performed for AKI and non AKI patients. (AU)