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Mortality prediction of serum neutrophil gelatinase-associated lipocalin in patients requiring continuous renal replacement therapy

Korean Journal of Internal Medicine 2021년 36권 2호 p.392 ~ 400
박요한, 반태현, 김형덕, 고은정, 이종민, 김석찬, 박철휘, 양철우, 김영수, 정병하,
소속 상세정보
박요한 ( Park Yo-Han ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
반태현 ( Ban Tae-Hyun ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Internal Medicine
김형덕 ( Kim Hyung-Duk ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
고은정 ( Ko Eun-Jeong ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
이종민 ( Lee Jong-Min ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
김석찬 ( Kim Seok-Chan ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
박철휘 ( Park Cheol-Whee ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
양철우 ( Yang Chul-Woo ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
김영수 ( Kim Yong-Soo ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine
정병하 ( Chung Byung-Ha ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Internal Medicine

Abstract


Background/Aims: We investigated whether serum neutrophil gelatinase-associated lipocalin (NGAL) can predict mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).

Methods: This study enrolled 169 patients who underwent serum NGAL testing at CRRT initiation from June 2017 to January 2019. The predictive power of serum NGAL level for 28-day mortality was compared to the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score and Sequential Organ Failure Assessment (SOFA) score via area under the receiver operating characteristic curve (AuROC) value.

Results: There were 55 survivors and 114 non-survivors at 28 days post-CRRT initiation. Median serum NGAL level was significantly higher in the non-survivor group than in the survivor group (743.0 ng/mL vs. 504.0 ng/mL, p = 0.003). The AuROC value of serum NGAL level was 0.640, which was lower than APACHE-II score and SOFA score values (0.767 and 0.715, respectively). However, in the low APACHE-II score group (< 27.5), AuROC value of serum NGAL was significantly increased (0.698), and it was an independent risk factor for 28 day-mortality (hazard ratio, 2.405; 95% confidence interval, 1.209 to 4.783; p = 0.012).

Conclusions: In patients with AKI requiring CRRT, serum NGAL levels may be useful for predicting short-term mortality in those with low APACHE-II scores.

키워드

Neutrophil gelatinase-associated lipocalin; Critical illness; Acute kidney injury; Renal replacement therapy; Mortality

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