Concentration and predictive value of plasma neutrophil gelatinase-associated lipocalin in patients with acute pancreatitis and acute kidney injury.

BACKGROUND

Acute kidney injury (AKI) is a severe complication of acute pancreatitis (AP) associated with increased morbidity and mortality. Early prediction of AKI remains a clinical challenge owing to the limitations of traditional biomarkers, such as serum creatinine.

AIM: To evaluate the concentration and predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with AP and AKI.

METHODS

This cross-sectional descriptive study was conducted from October 2021 to June 2023 at Bach Mai Hospital. In total, 219 patients were enrolled, including 51 patients with AP and AKI, 168 patients with AP but without AKI, and 35 healthy controls. Plasma NGAL levels were measured and compared between groups. Receiver operating characteristic curve analysis was performed to determine the predictive value of NGAL levels for the severity of AKI and AP.

RESULTS

Among AP and AKI cases, 47.1% were classified as Kidney Disease: Improving Global Outcomes stage 1, 33.3% as stage 2, and 19.6% as stage 3. The AP with AKI group (570.9 ng/mL) had significantly higher median plasma NGAL concentrations than the AP without AKI group (400.6 ng/mL) and the healthy control group (234.3 ng/mL) (P < 0.01). The NGAL levels increased proportionally with AKI severity. A plasma NGAL cutoff value of 504.29 ng/mL predicted AKI with 60.8% sensitivity and 68.4% specificity (area under the curve = 0.684; P < 0.001). A cutoff of 486.03 ng/mL predicted AP severity with 66.1% sensitivity and 66.4% specificity (area under the curve = 0.651; P < 0.005). NGAL positively correlated with international normalized ratio, urea, creatinine, lactate dehydrogenase, and lactate levels.

CONCLUSION

Plasma NGAL levels predicted both AKI development and disease severity. Therefore, NGAL should be considered a useful biomarker for the early evaluation of patients with AP.