Early Diagnostic and Prognostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Critically Ill Children With Septic Acute Kidney Injury

Background: Neutropil Gelatinase-Associated Lipocalin (NGAL) is a biomarker of acute kidney injury(AKI)even on top of chronic kidney disease. Objectives: was to determine NGAL levels in children as early diagnostic and prognostic factor for AKI in critically ill children with sepsis. Subjects and Methods: The present study was carried out on 120 children with sepsis admitted in Pediatric Intensive care Unit of Tanta University Hospital. They were subdividing into 3 groups, Group (1): 45 sepsis–non-AKI, Group (2): 45 sepsis with AKI. Group (3) 30 non sepsis–non-AKI as controls. Urine samples were collected daily for 5 days from the sepsis patients and urinary NGAL levels were measured by ELISA test for group 1on the admission day and on day 5 after admission while in group 2 on the admission day 24 h before the onset of AKI, and on the day of AKI onset while in group 3, on the admission day. Results: There was a significant increase in urinary NGAL levels in sepsis patients (groups 1 & 2) when compared with non sepsis patients (14.8 ± 4.2 and 5.5 ± 2.6 ng/ml, respectively; P < 0.001).ROC curve of NGAL reported that in sepsis patients who developed AKI (group 2), urinary NGAL preceded the rise in serum creatinine, and at its cutoff level of 33.1 ng/ml it predicted AKI with an area AUC of 0.96, sensitivity of 99%, and specificity of 85%; at its cutoff level of 48.7 ng/ml, it predicted the need for dialysis with AUC of 0.81, sensitivity of 84%, and specificity of 73%. Urine NGAL could not predict mortality among sepsis patients. Conclusion: Urinary NGAL can predict AKI well in critically ill septic pediatric patients and can predicted their indication for dialysis. Keywords: Acute Kidney Injury Prediction; Neutrophil Gelatinase-Associated Lipocalin; Sepsis