Abstract

Objective:

Almost half of intensive care patients are affected by acute kidney injury (AKI). The purpose of this study is to determine parameters that can be used for predicting of early (within 28 days) and late (within 90 days) mortality in patients who are followed-up with AKI in intensive care units.

Materials and Methods:

In this study, a dataset that contains 50 patients with AKI in intensive care units was used. This dataset contains blood urea nitrogen, creatinine, plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL), lactate dehydrogenase, alkaline phosphatase and gamma-glutamyl transpeptidase values of patients who were admitted to intensive care for various reasons and who developed AKI on the days 1, 3 and 7. In addition to these values, laboratory results such as serum electrolytes on day 1, blood gas; vital signs such as mean arterial pressure, central venous pressure; and demographic data were also recorded. Data mining techniques were applied to determine correlation between all of these data and mortality.

Results:

The threshold level of urinary NGAL on day 7 was determined to be 69 ng/mL, and strong correlation was found between this threshold level and early mortality. Similarly, the threshold level of plasma NGAL on day 7 was determined to be 150 ng/mL, and this was highly correlated with early mortality. Besides, strong correlation was also found between the difference in the urinary NGAL levels on day 1 and 7, and early mortality.

Conclusion:

In this study, plasma and urinary NGAL levels were found to be closely related to early mortality in patients who were followed-up with AKI in intensive care units. On the other hand, any parameter associated with late mortality was not found.

Keywords: Acute kidney injury, plasma NGAL, urinary NGAL, mortality, data mining

References

  1. Singbartl K, Joannidis M. Short-term effects of acute kidney injury. Crit Care Clin 2015;31:751-62.
  2. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015;41:1411-23.
  3. Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int 2013;84:457-67.
  4. Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015;385:2616-43.
  5. Karagöz P, Kefi A, Dündar PE, Canan S, Çivi M. Yogun Bakım Hastalarında RIFLE Sinıflaması ile Akut Böbrek Hasari insidansi ve Risk Faktörleri. J Turk Soc Intens Care 2015;13:16-25.
  6. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care 2004;8:204-12.
  7. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:31.
  8. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120:179-84.
  9. Büget Mİ, Özkilitçi E, Küçükgergin C, Seçkin Ş, Küçükay S, Yenigü Y, et al. Akut Böbrek Yetmezliğinde Erken Tanı: Nötrofil Gelatinoz İlişkili Lipokain (NGAL), Kidney İnjury Molekül-1 (KİM-1), ve İnterlokin-18 (İL-18), Sistatin-C. J Turk Soc Intens Care 2014;12:94-100.
  10. Kjeldsen L, Cowland JB, Borregaard N. Human neutrophil gelatinase-associated lipocalin and homologous proteins in rat and mouse. Biochim Biophys Acta 2000;1482:272-83.
  11. Cowland JB, Borregaard N. Molecular characterization and pattern of tissue expression of the gene for neutrophil gelatinase-associated lipocalin from humans. Genomics 1997;45:17-23.
  12. Shyam R, Patel ML, Sachan R, Kumar S, Pushkar DK. Role of urinary neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury in patients with circulatory shock. Indian J Crit Care Med 2017;21:740-5.
  13. Hemmerling TM, Cirillo F, Cyr S. Decision Support Systems in Medicine-Anesthesia, Critical Care and Intensive Care Medicine. Decision Support Systems: InTech; 2012.
  14. Özcan C. Veri madenciliğinin güvenlik uygulama alanları ve veri madenciliği ile sahtekarlık analizi: İstanbul Bilgi Üniversitesi; 2014.
  15. Sheha MA, Mabrouk MS, Sharawy A. Automatic detection of melanoma skin cancer using texture analysis. International Journal of Computer Applications 2012;42:22-6.
  16. Aksebzeci BH, Kayaalti Ö. Meme Kanseri Histopatolojik Görüntülerinin Bilgisayar Destekli Sınıflandırılması. Tıp Teknolojileri Ulusal Kongresi (TIPTEKNO); 2017: IEEE.
  17. Gursoy MI, Subast A, editors. A comparison of PCA, ICA and LDA in EEG signal classification using SVM. Signal Processing, Communication and Applications Conference, 2008 SIU 2008 IEEE 16th; 2008: IEEE.
  18. Tokmakçi M. A classification system for stenosis from mitral valve Doppler signals using adaptive network based fuzzy inference system. J Med Syst 2007;31:329-36.
  19. Mahmoodpoor A, Hamishehkar H, Fattahi V, Sanaie S, Arora P, Nader ND. Urinary versus plasma neutrophil gelatinase-associated lipocalin (NGAL) as a predictor of mortality for acute kidney injury in intensive care unit patients. J Clin Anesth 2018;44:12-7.
  20. http://dx.doi.org/10.17632 /579pxjyjz8.1 #file-a097cb11-01c2-43fb-98a5-1e0bb1211280.
  21. Hand DJ. Data mining: Statistics and more? The American Statistician. 1998;52:112-8.
  22. Han J, Pei J, Kamber M. Data mining: concepts and techniques: Elsevier; 2011.
  23. Quinlan JR. Simplifying decision trees. International Journal of Man-Machine Studies 1987;27:221-34.
  24. Yıldırım S. Tümevarım Öğrenme Tekniklerinden C4. 5’in İncelenmesi: Fen Bilimleri Enstitüsü; 2015.
  25. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813-8.
  26. Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2:431-9.
  27. Grams ME, Rabb H. The distant organ effects of acute kidney injury. Kidney Int 2012;81:942-8.
  28. Karadeniz Z, Tuncel Z, Yapıcı N, Kudsioğlu T, Coşkun Fİ, Nuraç H, et al. Akut Böbrek Hasarının Erken Tanısında Plazma NGAL (Neutrophil Gelatinase-Associated Lipocalin) Etkinliğinin Off-pump ve On-pump Kalp Cerrahisinde Karşılaştırılması. GKDA Derg 2013;19:168-74.
  29. Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A; NGAL Meta-analysis Investigator Group. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009;54:1012-24.
  30. Wang M, Zhang Q, Zhao X, Dong G, Li C. Diagnostic and prognostic value of neutrophil gelatinase-associated lipocalin, matrix metalloproteinase-9, and tissue inhibitor of matrix metalloproteinases-1 for sepsis in the Emergency Department: an observational study. Crit Care 2014;18:634.
  31. Ralib AM, Pickering JW, Shaw GM, Than MP, George PM, Endre ZH. The clinical utility window for acute kidney injury biomarkers in the critically ill. Crit Car 2014;18:601.
  32. Hjortrup PB, Haase N, Treschow F, Møller MH, Perner A. Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis. Acta Anaesthesiol Scand 2015;59:25-34.
  33. Yang HT, Yim H, Cho YS, Kym D, Hur J, Kim JH, et al. Assessment of biochemical markers in the early post-burn period for predicting acute kidney injury and mortality in patients with major burn injury: comparison of serum creatinine, serum cystatin-C, plasma and urine neutrophil gelatinase-associated lipocalinCritical Care 2014;18:151.

Copyright and license

Copyright © 2018 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Kayaaltı S, Kayaaltı Ö, Aksebzeci BH. Relationship Between Neutrophil Gelatinase-associated Lipocalin and Mortality in Acute Kidney Injury. Turk J Intensive Care. 2018;16(3):101-108. https://doi.org/10.4274/tybd.86158