Predictive value of urinary neutrophil gelatinase-associated lipocalin in detection of severe acute kidney injury in critically ill children

Aims and Objectives: The primary objective was to determine the positive and negative predictive values, sensitivity, and specificity of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for diagnosis of severe acute kidney injury (AKI). The secondary objectives were to find the association between uNGAL with day-3 cumulative fluid balance (CFB), requirement of kidney replacement therapy (KRT), and length of pediatric intensive care unit (PICU) stay. Materials and Methods: In this prospective cohort, uNGAL was done by chromatography on patients admitted at PICU in a tertiary care hospital with Pediatric Risk of Mortality III (PRISM III) score of >10. AKI was defined by KDIGO 2012 criteria. Urinary NGAL was done on all patients (>3 months to ≤12 years) with PRISM III score >10 on day 1 and day 3 of PICU admission who had no AKI on admission. Results: Out of 288 patients admitted with PRISM III score >10 and normal kidney function on admission, 58.3% developed AKI and 29.9% developed severe AKI. Day-3 uNGAL was found to be superior to day-1 uNGAL in detecting AKI with 96.4% sensitivity, 84.4% specificity, 85.04% PPV, and 96.26% NPV. The percentage increase in day-3 CFB and risk of requiring KRT was significantly (P < 0.001) higher in the groups with raised day-1 uNGAL and day-3 uNGAL. The length of PICU stay was significantly correlated to the group with raised day-3 uNGAL (P < 0.001). Conclusion: Urinary NGAL had a good predictive value in detecting severe AKI in critically ill children. It is also associated with requirement of KRT and day-3 CFB. Duration of PICU stay was significantly associated with day-3 uNGAL (P < 0.001).