Dynamic Changes of Plasma Neutrophil Gelatinase-Associated Lipocalin Predicted Mortality in Critically Ill Patients with Systemic Inflammatory Response Syndrome.

ABSTRACT

BACKGROUND AND AIMS: About 50% of patients admitted to the Intensive Care Unit have systemic inflammatory response syndrome (SIRS), and about 10%-20% of them died. Early risk stratification is important to reduce mortality. Plasma neutrophil gelatinase-associated lipocalin (NGAL) is increased by inflammation and infection. Its ability to predict mortality in SIRS patients is of interest. We evaluated the ability of serial measurement of NGAL for the prediction of mortality in critically ill patients with SIRS. MATERIALS AND METHODS: This is a secondary analysis of a single-center, prospective, observational study. Patients who fulfill the SIRS criteria were recruited in the study. Delta NGAL at 24 and 48 h (ΔNGAL-24 and ΔNGAL-48) was defined as 24 and 48 h NGAL minus day 1 NGAL; NGAL clearance (NGALc) was defined as percentage of ΔNGAL over day 1 NGAL. The primary outcome of the study is in-hospital mortality. RESULTS: A total of 151 patients were analyzed, of which 53 (35%) died. Nonsurvivors were older (51 vs. 45, P = 0.03) and had higher Sequential Organ Failure Assessment (9 ± 7 vs. 7 ± 4, P = 0.02) and Simplified Acute Physiology Score II (47 ± 15 vs. 40 ± 15, P = 0.01) scores as compared to survivors. NGAL concentrations over 3 days were higher in nonsurvivors compared to survivors (repeated measures analysis of variance, P = 0.02). Day 1 NGAL, ΔNGAL-24, and NGALc-24 were not independently predictive of mortality. However, day 3 NGAL, ΔNGAL-48, and NGALc-48 were predictive after adjusted for age and severity of illness (odds ratio 9.1 [1.97-41.7]). CONCLUSIONS: NGAL dynamics over 48 h independently predicted mortality in critically ill patients with SIRS. This could assist clinicians in risk stratification of this group of high-risk patients.