Does serum neutrophil gelatinase-associated lipocalin level predict acute kidney injury in patients with acute rhabdomyolysis in the emergency department? A multicentre prospective study.
Stephane Pommet, Fabien Coisy, Christophe Demattei, Lucille Balaguer, David-Paul de Bauwere, Laura Grau-Mercier, Thibaut Markarian, Xavier Bobbia, Romain Genre Grandpierre
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Abstract
Objectives: The major complication of rhabdomyolysis is acute kidney injury (AKI), which requires prompt treatment. Currently, few biomarkers are available for the early detection of AKI. Serum neutrophil gelatinase-associated lipocalin (NGAL) has been suggested as an early biomarker for renal ischemia. However, its capacity to predict AKI in patients presenting with rhabdomyolysis in the emergency department (ED) remains unclear. The aim of this study was to evaluate the ability of NGAL to predict 48-hour AKI.
Design: Prospective, multicentre study.
Setting: Five adult EDs in France from August 2013 to December 2015.
Participants: NGAL levels were measured on ED admission in patients with rhabdomyolysis. A total of 197 patients were enrolled, and 189 (96%) were analysed, of whom 89 (47%) were women. Patients were included if they presented to the ED with rhabdomyolysis and a creatine phosphokinase (CPK) level above 1000 IU/L. Exclusion criteria were pregnancy, presentation with acute coronary syndrome, the need for iodinated contrast, chronic dialysis or recent use of nephrotoxic drugs (within 72 hours prior to the ED visit). Patients who withdrew consent or had AKI due to other causes were also excluded.
Primary and secondary outcome measures: The primary outcome was AKI at 48 hours, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary outcomes included in-hospital mortality, length of hospital stay, admission to intensive care and the need for renal replacement therapy.
Results: Overall, 54 (29%) patients developed AKI by day 2. The area under the ROC curve (AUC-ROC) for NGAL in predicting AKI on day 2 was 0.60 (95% CI 0.51 to 0.70), with an optimal cut-off of 129 ng/mL. The sensitivity was 0.65, and specificity was 0.50. After adjustment for CPK levels, age, sex and oxygen saturation, the AUC-ROC for predicting AKI on day 2 increased slightly to 0.64 (95% CI 0.54 to 0.74).
Conclusion: NGAL has limited ability to predict day 2 AKI in patients presenting with acute rhabdomyolysis in the ED.
Trail registration number: NCT01544231.Comité de Protection des Personnes Sud Méditerranée III n°2011-A01059-32.
目的：横纹肌溶解症的主要并发症是急性肾损伤（AKI）：横纹肌溶解症的主要并发症是急性肾损伤（AKI），需要及时治疗。目前，用于早期检测 AKI 的生物标记物很少。血清中性粒细胞明胶酶相关脂质体（NGAL）被认为是肾缺血的早期生物标志物。然而，它预测急诊科（ED）横纹肌溶解症患者 AKI 的能力仍不明确。本研究旨在评估 NGAL 预测 48 小时 AKI 的能力：前瞻性多中心研究：2013年8月至2015年12月，法国五家成人急诊室：对横纹肌溶解症患者入院时的NGAL水平进行测量。共登记了 197 名患者，分析了 189 名（96%）患者，其中 89 名（47%）为女性。如果患者在急诊室就诊时出现横纹肌溶解症，且肌酸磷酸激酶（CPK）水平超过 1000 IU/L，则将其纳入研究范围。排除标准包括怀孕、急性冠状动脉综合征、需要使用碘造影剂、慢性透析或近期使用肾毒性药物（就诊前 72 小时内）。退出同意或因其他原因导致 AKI 的患者也被排除在外：主要结果是 48 小时后的 AKI，根据肾脏疾病：KDIGO）标准定义。次要结果包括院内死亡率、住院时间、重症监护入院率和肾脏替代治疗需求：总体而言，54 名（29%）患者在住院第 2 天出现了 AKI。NGAL预测第2天AKI的ROC曲线下面积（AUC-ROC）为0.60（95% CI 0.51至0.70），最佳临界值为129纳克/毫升。灵敏度为 0.65，特异性为 0.50。对 CPK 水平、年龄、性别和血氧饱和度进行调整后，预测第 2 天 AKI 的 AUC-ROC 略有增加，为 0.64（95% CI 0.54 至 0.74）：NGAL预测急诊室急性横纹肌溶解症患者第2天AKI的能力有限：NCT01544231.Comité de Protection des Personnes Sud Méditerranée III n°2011-A01059-32.
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