Neutrophil Gelatinase-Related Lipocalin and Renal Resistive Index in the Diagnosis and Prognosis of Sepsis-Associated Acute Kidney Injury: A Cross-Sectional Study from Türkiye.

Abstract

Background: Acute kidney injury (AKI) is common in intensive care unit (ICU) and sepsis-induced AKI (SI-AKI) is a cause of the high mortality and morbidity.

Aim: To determine the use of neutrophil gelatinase-related lipocalin (NGAL) and Renal Resistive Index (RRI) in the predicting the development of AKI and mortality in patients with sepsis in the ICU.

Methods: Patients with sepsis who were admitted into the ICU were divided into the AKI and non-AKI groups. On the first and fifth days after sepsis diagnosis, blood samples were taken for NGAL levels while RRIs were measured via doppler ultrasound. Simultaneously, fluid responsiveness and perfusion status were evaluated with pleth variability index (PVI) and pulsatility index (PI). Twenty-eight day mortality was recorded.

Results: The mean age of 101 patients was 63 years and 69% were male. On the first day, the NGAL (P = 0.002), RRI (P = 0.001) and PVI (P = 0.001) were significantly higher while the PI (P = 0.018) was lower in the AKI group. On the fifth day, the RRI and PVI were significantly higher in the AKI group. (P = 0.001). The RRI and PVI on the first and 5th days were significantly higher, while the PI was lower in non-surviving group (P = 0.001). The parameter that best predicted the development of AKI was RRI (area under curve [AUC] = 0.898, P = 0.001). The RRI, PI and PVI values were significantly associated with mortality (respectively AUC value 0.722, 0.714, 0.700, P = 0.001).

Conclusions: The RRI is an important marker for predicting AKI in the early phase of sepsis and mortality in acutely ill patients, while NGAL is a biomarker that can predict AKI.