Prognostic Utility of Ngal in Cardiac ICU

Abstract

Introduction: There is paucity of data for using NGAL (Neutrophil Gelatinase associated Lipocalin) as a biomarker in management of acute kidney injury (AKI) in patients admitted in cardiac ICU. Our study aims to evaluate the role of NGAL as an early surrogate marker in predicting AKI and mortality in patients of cardiac diseases. Study Design: Prospective observational study. Place and Duration of Study: Department of cardiology, Swaroop Rani Nehru (SRN) Hospital, Prayagraj, India between August 2020 to March 2021. Methodology: The study included critically ill cardiac patients of various etiologies requiring admission to the cardiac ICU. Patients of chronic kidney disease or other renal diseases were excluded from the study. Samples for blood and urinary NGAL and other laboratory parameters were collected within 8 hours of admission to the ICU. Results: 152 patients were included in the study, out of which 56 patient who developed acute kidney injury were the cases, while 96 were our controls. The cutoffs for serum and urinary neutrophil gelatinase associated lipocalin for predicting acute kidney injury were found to be >42.5 ng/mL and >40.5 ng/mL respectively (P <0.001). A positive correlation between low density lipoprotein and neutrophil gelatinase associated lipocalin was also found (P=0.0005 and P=0.0011 for serum and urinary NGAL respectively). NGAL was found to have a prognostic role and lower values were significantly associated with increased chances of survival (P=0.0201 and 0.0255 for serum and urinary NGAL respectively). Conclusion: Our study clearly states that NGAL measurement at the time of admission can be used to predict development of acute kidney injury as well as mortality, hence, improving the outcome of patients with cardiac diseases.