Acute kidney injury (AKI) is a consequence of several diseases that can severely damage kidney function. It is a frequent complication of hospitalization and very common in critically ill patients because of other serious illnesses, such as septic conditions. New diagnostic options, including renal biomarkers, may help in early diagnosis. Our study included 46 patients, 31 with AKI and 15 without AKI on admission. Blood samples were collected on the first, fourth, and seventh days of treatment, and in addition to basic biochemical parameters, neutrophil gelatinase-associated lipocalin (NGAL) levels in serum were also examined. Data from the first and seventh day were used for statistical analysis. On the first follow-up day, NGAL values were categorized according to an optimal cut-off value of 290 µg/l. We demonstrated that if NGAL levels were higher, the risk of renal injury increased approximately 16 times. Other results showed that NGAL levels were moderately correlated with serum creatinine (r = 0.613, p < 0.0001), procalcitonin (PCT) (r = 0.627, p < 0.0001), and AKI stage (r = 0.589, p < 0.0001). There was also a significant positive correlation with SOFA (Sequential Organ Failure Assessment) score (r = 0.395, p = 0.007). Early diagnosis and treatment are crucial in managing AKI and preventing further kidney damage. NGAL levels can increase within a few hours after injury, making it a useful tool for early AKI detection and diagnosis. Key words: Acute kidney injury, Biomarker, NGAL, Sepsis.

Department of Internal Medicine 3 Nephrology Rheumatology and Endocrinology Faculty of Medicine and Dentistry University Hospital Olomouc and Palacky University Olomouc Olomouc Czech Republic

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Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394:1949–64. doi: 10.1016/S0140-6736(19)32563-2. PubMed DOI

Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411–23. doi: 10.1007/s00134-015-3934-7. PubMed DOI

Bagshaw SM, George C, Bellomo R ANZICS Database Management Committee. Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care. 2008;12:R47. doi: 10.1186/cc6863. PubMed DOI PMC

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2:1–138.

Kashani K, Cheungpasitporn W, Ronco C. Biomarkers of acute kidney injury: The pathway from discovery to clinical adoption. Clin Chem Lab Med. 2017;55:1074–89. doi: 10.1515/cclm-2016-0973. PubMed DOI

Klein SJ, Brandtner AK, Lehner GF, et al. Biomarkers for prediction of renal replacement therapy in acute kidney injury: A systematic review and meta-analysis. Intensive Care Med. 2018;44:323–36. doi: 10.1007/s00134-018-5126-8. PubMed DOI PMC

Kjeldsen L, Johnsen AH, Sengelov H, Borregaard N. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase. J Biol Chem. 1993;268:10425–32. doi: 10.1016/S0021-9258(18)82217-7. PubMed DOI

Ronco C. NGAL: An emerging biomarker of acute kidney injury. the international journal of artificial organs. 2008;31:199–200. doi: 10.1177/039139880803100302. PubMed DOI

Bolignano D, Donato V, Coppolino G, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a marker of kidney damage. Am J Kidney Dis. 2008;52:595–605. doi: 10.1053/j.ajkd.2008.01.020. PubMed DOI

Chang W, Zhu S, Pan C, et al. Predictive utilities of neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis. Clin Chim Acta. 2018;481:200–6. doi: 10.1016/j.cca.2018.03.020. PubMed DOI

Wu Y, Yu C, Zhou Y, et al. Risk stratification and prognostic value of serum neutrophil gelatinase-associated lipocalin (sNGAL) in sepsis patients. Acta Biochim Pol. 2022;69:113–17. doi: 10.18388/abp.2020_5755. PubMed DOI

Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315:801–10. doi: 10.1001/jama.2016.0287. PubMed DOI PMC

Kim S, Kim HJ, Ahn HS, et al. Is plasma neutrophil gelatinase-associated lipocalin a predictive biomarker for acute kidney injury in sepsis patients? A systematic review and meta-analysis. J Crit Care. 2016;33:213–23. doi: 10.1016/j.jcrc.2016.02.014. PubMed DOI

Nath CK, Rajkhowa P, Barman B, et al. Plasma neutrophil gelatinase-associated lipocalin (NGAL): A candidate biomarker to detect early acute kidney injury (AKI) for at-risk intensive care admissions. J Family Med Prim Care. 2022;11:3681–6. doi: 10.4103/jfmpc.jfmpc_2316_21. PubMed DOI PMC

Albert C, Zapf A, Haase M, et al. Neutrophil gelatinase-associated lipocalin measured on clinical laboratory platforms for the prediction of acute kidney injury and the associated need for dialysis therapy: a systematic review and meta-analysis. Am J Kidney Dis. 2020;76:826–41.e1. doi: 10.1053/j.ajkd.2020.05.015. PubMed DOI PMC

Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A NGAL Meta-analysis Investigator Group. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009 Dec;54(6):1012–24. doi: 10.1053/j.ajkd.2009.07.020. PubMed DOI

Wheeler DS, Devarajan P, Ma Q, Harmon K, Monaco M, Cvijanovich N, Wong HR. Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med. 2008 Apr;36(4):1297–303. doi: 10.1097/CCM.0b013e318169245a. PubMed DOI PMC

Hur M, Kim H, Lee S, et al. Diagnostic and prognostic utilities of multimarkers approach using procalcitonin, B-type natriuretic peptide, and neutrophil gelatinase-associated lipocalin in critically ill patients with suspected sepsis. BMC Infect Dis. 2014;14:224. doi: 10.1186/1471-2334-14-224. PubMed DOI PMC

Nielsen MJ, Baines P, Jennings R, et al. Procalcitonin, C-reactive protein, neutrophil gelatinase-associated lipocalin, resistin and the APTT waveform for the early diagnosis of serious bacterial infection and prediction of outcome in critically ill children. PLoS One. 2021;16:e0246027. doi: 10.1371/journal.pone.0246027. PubMed DOI PMC

Jahaj E, Vassiliou AG, Pratikaki M, et al. Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) Could provide better accuracy than creatinine in predicting acute kidney injury development in critically ill patients. J Clin Med. 2021;10:5379. doi: 10.3390/jcm10225379. PubMed DOI PMC

Kümpers P, Hafer C, Lukasz A, et al. Serum neutrophil gelatinase-associated lipocalin at inception of renal replacement therapy predicts survival in critically ill patients with acute kidney injury. Crit Care. 2010;14:R9. doi: 10.1186/cc8861. PubMed DOI PMC

Casas-Aparicio G, Alvarado-de la Barrera C, Escamilla-Illescas D, et al. Role of urinary kidney stress biomarkers for early recognition of subclinical acute kidney injury in critically Ill COVID-19 Patients. Biomolecules. 2022;12:275. doi: 10.3390/biom12020275. PubMed DOI PMC

de Geus HR, Betjes MG, Schaick Rv, Groeneveld JA. Plasma NGAL similarly predicts acute kidney injury in sepsis and nonsepsis. Biomark Med. 2013;7:415–21. doi: 10.2217/bmm.13.5. PubMed DOI

Marakala V. Neutrophil gelatinase-associated lipocalin (NGAL) in kidney injury - A systematic review. Clin Chim Acta. 2022;536:135–41. doi: 10.1016/j.cca.2022.08.029. PubMed DOI

Tsai HI, Lu YC, Kou HW, et al. The Combination of SOFA Score and Urinary NGAL May Be an Effective Predictor for Ventilator Dependence among Critically Ill Surgical Patients: A Pilot Study. Diagnostics (Basel) 2021;11:1186. doi: 10.3390/diagnostics11071186. PubMed DOI PMC

Makris K, Markou N, Evodia E, et al. Urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in critically ill multiple trauma patients. Clin Chem Lab Med. 2009;47:79–82. doi: 10.1515/CCLM.2009.004. PubMed DOI

Legrand M, Collet C, Gayat E, et al. Accuracy of urine NGAL commercial assays in critically ill patients. Intensive Care Med. 2013;39:541–2. doi: 10.1007/s00134-012-2788-5. PubMed DOI

Bolignano D, Basile G, Parisi P, et al. Increased plasma neutrophil gelatinase-associated lipocalin levels predict mortality in elderly patients with chronic heart failure. Rejuvenation Res. 2009;12:7–14. doi: 10.1089/rej.2008.0803. PubMed DOI