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Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients

Mårtensson, J., Glassford, N.J., Jones, S., Eastwood, G.M., Young, H., Peck, L., Ostland, V., Westerman, M., Venge, P. and Bellomo, R. 2015, Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients, Minerva anestesiol, vol. 81, no. 11, pp. 1192-1200.

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Title Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients
Author(s) Mårtensson, J.
Glassford, N.J.
Jones, S.
Eastwood, G.M.
Young, H.
Peck, L.
Ostland, V.
Westerman, M.
Venge, P.
Bellomo, R.
Journal name Minerva anestesiol
Volume number 81
Issue number 11
Start page 1192
End page 1200
Total pages 9
Publisher Edizioni Minerva Medica
Place of publication Turin, Italy
Publication date 2015-11
ISSN 1827-1596
Keyword(s) acute kidney injury
aged
biomarkers
critical care
female
hepcidins
humans
Lipocalin-2
male
middle aged
patients
predictive value of tests
prospective studies
LCN2 protein
oliguria
iron
Science & Technology
Life Sciences & Biomedicine
Anesthesiology
Critical Care Medicine
General & Internal Medicine
Summary BACKGROUND: Labile iron is important in the pathogenesis of acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin control iron metabolism and are upregulated during renal stress. However, higher levels of urinary NGAL are associated with AKI severity whereas higher urinary hepcidin levels are associated with absence of AKI. We aimed to investigate the value of combining both biomarkers to estimate the severity and progression of AKI in intensive care unit (ICU) patients. METHODS: Urinary NGAL and hepcidin were quantified within 48 hours of ICU admission in patients with the systemic inflammatory response syndrome and early kidney dysfunction (oliguria for ≥ 2 hours and/or a 25 µmol/L creatinine rise from baseline). Diagnostic and prognostic characteristics were assessed by logistic regression and receiver operating characteristics (ROC) analysis. RESULTS: Of 102 patients, 26 had mild AKI and 28 patients had severe AKI on admission. Sepsis (21%), cardiac surgery (17%) and liver failure (9%) were primary admission diagnoses. NGAL increased (P=0.03) whereas hepcidin decreased (P=0.01) with increasing AKI severity. The value of NGAL/hepcidin ratio to detect severe AKI was higher than when NGAL and hepcidin were used individually and persisted after adjusting for potential confounders (adjusted OR 2.40, 95% CI 1.20-4.78). The ROC areas for predicting worsening AKI were 0.50, 0.52 and 0.48 for NGAL, 1/hepcidin and the NGAL/hepcidin ratio. CONCLUSION: The NGAL/hepcidin ratio is more strongly associated with severe AKI than the single biomarkers alone. NGAL and hepcidin, alone or combined as a ratio, were unable to predict progressive AKI in this selected ICU cohort.
Language eng
Field of Research 110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, Edizioni Minerva Medica
Persistent URL http://hdl.handle.net/10536/DRO/DU:30086906

Document type: Journal Article
Collection: School of Nursing and Midwifery
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