Background
Sepsis is a syndrome involving life-threatening organ dysfunction. The present study aimed to determine whether septic AKI, ARDS, DIC, and shock can be predicted more readily by combining uNGAL values and inflammation-based prognostic scores, over the use of uNGAL values alone.
Methods
Adult patients diagnosed with sepsis according to the Sepsis-3 definition prospectively examined. Urine samples were collected from each patient to measure uNGAL after ICU entry at the following time points: immediately after and 2, 3, and 4 days after ICU entry. GPS, NLR, PLR, PI, and PNI were examined immediately after ICU entry. For category classification, a total score was calculated (hereafter, “inflammation-NGAL score [iNS]”) as follows: a score of 1 was assigned if uNGAL values and inflammation-based prognostic scores immediately after ICU entry were above cut-offs determined by ROC curve analysis for 28-day mortality; a score of 0 was assigned if the values were below the cut-offs (total score range, 0–2 points). As an example of nomenclature, the combination of uNGAL and NLR is presented as “iNS NGAL-NLR.” uNGAL, inflammation-based prognostic scores, iNS, and changes in uNGAL relative to uNGAL values immediately after ICU entry at each sampling point were compared between patients with septic AKI, ARDS, DIC, or shock after ICU entry and those without these disorders.
Results
ROC curve analyses yielded the following cut-off values: AKI: 438.5 (ng/ml) for uNGAL at Day 1 (AUC, 0.8), 476.9 (ng/ml) for uNGAL at Day 2 (AUC, 0.86), 123.8 (ng/ml) for uNGAL at Day 3 (AUC, 0.81), 133.6 (ng/ml) for uNGAL at Day 4 (AUC, 0.78), 1.0 for iNS NGAL-NLR (AUC, 0.75), 2.0 for iNS NGAL-PI (AUC, 0.77), DIC; 648.5 (ng/ml) for uNGAL at Day 1 (AUC, 0.77); shock; 123.8 (ng/ml) for uNGAL at Day 3 (AUC, 0.71) and 9 for SOFA (AUC, 0.71). Multivariate logistic regression analyses revealed iNS NGAL-PI to be a significant independent predictor of AKI (OR, 20.62; 95%CI, 1.03–412.3; p = 0.048).
Conclusions
uNGAL and iNS NGAL-PI were found to be predictors of septic AKI, DIC, and shock. Combining PI with uNGAL values improved the predictive value of uNGAL variables for septic AKI.