Plasma NGAL predicts early acute kidney injury no earlier than s-creatinine or cystatin C in severely burned patients

• We studied serum creatinine, cystatin-c, and plasma NGAL in 19 patients with severe burns for one week after injury.
• Serum creatinine and cystatin-c reacted more rapidly and reliably predicted renal insufficiency compared to NGAL.
• This study could not demonstrate plasma NGAL as a superior biomarker to creatinine or cystatin-c.

IntroductionNeutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker used in acute kidney injury (AKI) diagnostics. Studies on burn patients have highlighted it as a promising biomarker for early detection of AKI. This study was designed to discover whether plasma NGAL is as a biomarker superior to serum creatinine and cystatin C in detecting AKI in severely burned patients.MethodsNineteen subjects were enrolled from March 2013 to September 2014 in the Helsinki Burn Centre. Serum creatinine, cystatin C, and plasma NGAL were collected from the patients at admission and every 12 h during the first 48 h and thereafter daily until seven days following admission. AKI was defined by acute kidney injury network criteria.ResultsNine (47%) developed AKI during their intensive care unit stay and two (11%) underwent renal replacement therapy. All biomarkers were significantly higher in the AKI group but serum creatinine- and cystatin C values reacted more rapidly to changes in kidney function than did plasma NGAL. Plasma NGAL tended to rise on average 72 h ± 29 h (95% CI) later in patients with early AKI than did serum creatinine. Area-under-the-curve values calculated for each biomarker were 0.92 for serum creatinine, 0.87 for cystatin C, and 0.62 for plasma NGAL predicting AKI by the receiver-operating-characteristic method.ConclusionThis study demonstrated serum creatinine and cystatin C as faster and more reliable biomarkers than plasma NGAL in detecting early AKI within one week of injury in patients with severe burns.