腎臓学と治療学ジャーナル

NGAL-A Promising Biomarker for AKI in Severe COVID-19 Disease and Its Prognostic Role: A Prospective Study

Abstract

Anubhuti Bhardwaj1*, Upma Narain2 and Arvind Gupta1

Background: COVID-19 disease has stunned the world with its relentless spread and high mortality rates. Acute kidney injury has been an important consequence of the disease, contributing to mortality. There is unavailability of data for using neutrophil gelatinase associated lipocalin as a biomarker for acute kidney injury in patients with severe COVID-19 disease.

Aim: To evaluate the role of inflammatory marker neutrophil gelatinase associated lipocalin in severe COVID-19 disease.

Methods: A prospective observational study was conducted at various tertiary care hospitals in Prayagraj from January 1st 2021 to March 15th 2021, which included only patients with severe COVID-19 disease requiring ICU admission. Patients of known renal diseases were excluded from the study. The study was done on 110 patients, out of which 5 patients were excluded. Blood as well as urinary samples for neutrophil gelatinase associated lipocalin and the other laboratory parameters were collected within 8 hours of admission. The patients were followed until the hospital stay, and investigations were repeated every 3 days. The primary outcome was development of acute kidney injury, while secondary outcomes included-need of renal replacement therapy such as hemodialysis, mortality. Patients who developed renal dysfunction were noted as our cases and the others were noted as controls.

Results: The study was done on 105 patients, out of which 60 developed AKI (Acute kidney injury) and were noted as cases while 45 were our controls. The cutoffs for serum and urinary neutrophil gelatinase associated lipocalin for predicting acute kidney injury were found to be >91 and >80.6 respectively (p value<0.001). Serum and urinary NGAL had correlation coefficient of 0.462 and 0.380 with p value 0.005 and 0.02 respectively. Serum and urinary neutrophil gelatinase associated lipocalin showed significant predictive values for requirement of hemodialysis (renal replacement therapy) with p-value of 0.007 and 0.003 respectively, using multivariate analysis. Serum and urinary neutrophil gelatinase associated lipocalin at values >136.5 and >131 respectively were found to predict mortality (p value<0.001).

Conclusion: Neutrophil gelatinase associated lipocalin correlates strongly with development of acute kidney injury and the various radiological changes. Thus, it can be used as a prognostic marker in severe COVID-19 disease.