SESSION TITLE: Non Pulmonary Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Since multidrug resistant gram negative organism have been increasing, polymyxin E (colistin) has been reintroduced despite its nephrotoxicity. Recently, urine neutrophil gelatinase-associated lipocalin (NGAL) is a promising novel biomarker that correlates with the severity and outcome of acute kidney injury (AKI). However, its performance of colistin- induced AKI had not been well described. Therefore, we performed this study to estimate the diagnostic accuracy of urine NGAL for early detection of colistin-induced AKI in patients who were treated with colistin at an intensive care unit (ICU).
METHODS: This study was prospective observational study. We enrolled the critically ill patients treated with colistin at Hallym University Chuncheon Sacred Heart Hospital. Clinical data and creatinine were collected daily. Urine NGAL was measured at 2 hour, 24 hour after colistin injection. The primary outcome was a difference in urine NGAL between AKI group and non-AKI group. AKI was defined as RIFLE (Risk, injury, Failure, Loss, End Stage Kidney Disease) criteria.
RESULTS: Of 45 patients, 25 (55.6%) had AKI during their ICU day. Urine NGAL at 2 hour was significantly increased in patients with AKI group (median, 154.5 ng/ml, IQR 16.7-282.2 ng/ml) compared to those without AKI group (median, 59.9 ng/ml, IQR 15-164.1 ng/ml, p-value=0.000). But serum creatinine did not have difference between AKI group (median, 0.83 mg/dl, IQR 0.4 -1.9 mg/dl) and non-AKI group (median, 0.7 mg/dl, IQR 0.4-1.2 mg/dl, p-value 0.18). The parameter of urine NGAL at 2 hour was a good prognostic marker for AKI development (area under ROC 0.868, 95% confidential interval (CI) 0.756-0.979), but there was no difference of increment of urine NGAL at 24 hour between AKI group and non-AKI group (p-value = 0.55).
CONCLUSIONS: Urine NGAL is an useful early marker for colistin-induced AKI in adult ICU population.
CLINICAL IMPLICATIONS: Early identification of high risk patients using urine NGAL may allow cessation of colistin therapy or potentially beneficial therapies to be initiated early in the disease process.
DISCLOSURE: The following authors have nothing to disclose: Myung-Goo Lee, Chang Yul Lee, So Young Park
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