Serum NGAL in Critically Ill Children in ICU from a Single Center in Egypt

Introduction. The mortality and morbidity associated with acute kidney injury (AKI), unfortunately, remain unacceptably high. We aimed to detect the extent of serum neutrophil gelatinase-associated lipocalin (NGAL) to early detect AKI in critically ill children. Subjects and Methods. This is a case control study. It included 75 subjects that include 15 as controls and 60 critically ill children. Patients were further subdivided according to RIFLE criteria into two other categories: patients who developed AKI and patients who did not develop AKI. Serum NGAL assayed on admission and after 3 days. Results. There was significant increase in the level of NGAL among patients group when compared with control group. Also, 21.7% of children admitted to PICU developed AKI from which 8.3% needed dialysis. The receiver operating characteristic curve of NGAL at day 0 revealed AUC of 0.63 with 95% CI of 0.50–0.77. At a cutoff value of 89.5？ng/mL, the sensitivity of NGAL was 84.6%, while specifcity was 59.6%, positive predictive value was 36.7%, negative predictive value was 68.4%, and accuracy was 93.3% in diagnosis of AKI. Conclusion. We found that NGAL acts as a sensitive marker rather than a specific one for AKI. At the same time, it presents as a negative predictive value more valuable than being a positive predictive value in detecting AKI. 1. Introduction Acute kidney injury (AKI), formerly known as acute renal failure, continues to represent a very common and potentially devastating problem in critically ill children and adults. The reported incidence of AKI in this population varies greatly due to the lack of a standard consensus definition. For example, AKI affects between 5% and 50% of critically ill patients in reported series [1]. Unfortunately, the mortality and morbidity associated with AKI remain unacceptably high (up to 80% mortality in critically ill children and adults with multiple organ dysfunction syndrome (MODS)). While this dismal prognosis is partly attributable to other comorbid conditions, recent studies have revealed that AKI may be an independent risk factor for mortality in both critically ill children [2] and adults [3]. Acute kidney injury is typically diagnosed by measuring serum creatinine. However, it is well known that creatinine is an unreliable and insensitive indicator during early acute changes in kidney function. First, serum creatinine concentrations may not change until about 50% of kidney function has already been lost. Second, serum creatinine does not accurately depict kidney function until a steady state has been reached,