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2015 ; 196
(2
): 382-7
Nephropedia Template TP
Sen S
; Godwin ZR
; Palmieri T
; Greenhalgh D
; Steele AN
; Tran NK
J Surg Res
2015[Jun]; 196
(2
): 382-7
PMID25890435
show ga
BACKGROUND: Early detection of acute kidney injury (AKI) in severely burn-injured
patients can help alter treatment to prevent progression to acute failure and
reduce the need for renal replacement therapy. We hypothesized that whole blood
neutrophil gelatinase-associated lipocalin (NGAL) will be increased in severely
burn-injured patients who develop AKI during acute resuscitation. MATERIALS AND
METHODS: We performed a prospective observation study of adult burn patients with
a 20% total body surface area (TBSA) burned or greater burn injury. Two-hour
serial measurements of NGAL, serum creatinine (Cr), and hourly urine output (UO)
were collected for 48 h after admission. Our primary goal was to correlate the
risk of AKI in the first week after burn injury with serial NGAL levels in the
first 48 h after admission. Our secondary goal was to determine if NGAL was an
earlier independent predictor of AKI compared with Cr and UO. RESULTS: We
enrolled 30 adult (age ? 18 y) burn patients with the mean ± standard deviation
age of 40.9 ± 15.4 and mean TBSA of 46.4 ± 22.4. Fourteen patients developed AKI
within the first 7 d after burn injury. There were no differences in age, TBSA,
fluid administration, mean arterial pressure, UO, and Cr between AKI and no-AKI
patients. NGAL was significantly increased as early as 4 h after injury (182.67 ±
83.3 versus 107.37 ± 46.15) in the AKI group. Controlling for age, TBSA, and
inhalation injury, NGAL was a predictor of AKI at 4 h after injury (odds ratio,
1.02) and remained predictive of AKI for the period of more than the first 24 h
after admission. UO and Cr were not predictive of AKI in the first 24 h after
admission. CONCLUSIONS: Whole blood NGAL is markedly increased in burn patients
who develop AKI in the first week after injury. In addition, NGAL is an early
independent predictor of AKI during acute resuscitation for severe burn injury.
UO and Cr are not predictive of AKI during this time period.