Predictive effect of neutrophil gelatinase-associated apolipoprotein (NGAL) on prognosis in patients with sepsis/septic shock

doi:10.3877/cma.j.issn.2095-9133.2020.04.002

Abstract

Abstract:

Objective

To investigate the predictive effect of neutrophil gelatinase-associated apolipoprotein (NGAL) on prognosis in patients with sepsis and septic shock.

Methods

In this study, 84 patients who were admitted to the emergency department of Ruijin Hospital from January 31, 2017 to January 31, 2019 and were clearly diagnosed with sepsis/septic shock were selected as the research subjects to conduct retrospective case analysis, including 53 males , 31 females, aged 18 to 80 years, with average age (56.5ubjects to conduct retrospective case analysis, including 53 males , 31 femaleere divided into the survival group (n=62) and the death group (n=22). The plasma NGAL levels were measured on the first day, the third day, and the seventh day of the patient’s admission, and the clinical results of the two groups were compared. Differences in data and laboratory examination index levels were screened out for comparison of observation indexes with statistical significance, and Pearson correlation analysis was used to compare the correlation between NGAL and other prognostic indexes. The receiver operating characteristic curve (ROC) curve was then used to determine the predictive value of NGAL for the occurrence of in-hospital death in patients with sepsis/septic shock and whether continuous renal replacement therapy (CRRT) was required.

Results

The NGAL concentration of patients in the death group was [(2 188.4±2 280.8) ng/mL vs.(538.2±777.4)ng/mL] on day 1 and [(2 045.5±2 388.8)ng/mL vs.(553.8±836.4)ng/mL] and the 7th day [(1 512.4±1 840.9)ng/mL vs.(192.3±410.2)ng/mL] were significantly higher than those in the survival group, and the differences were statistically significant (P<0.05). The patientr than those in thsequential organ failure assessment (SOFA) (r=0.4601), acute physiology and chronic health evaluation (APACHE Ⅱ) (r=0.37), lactic acid (r=0.41) and creatinine (r=0.48) had a strong positive correlation (P<0.05). The prognostic value of NGAL level on day 7 [area under the curve (AUROC)=0.85, 95% CI: 0.70-0.99] was higher than that on day 1 (AUROC=0.71, 95% CI: 0.55-0.88) and the third day (AUROC=0.72, 95%CI: 0.55-0.88). The predictive value of creatinine and NGAL on day 3 for CRRT was better than that on day 1 and day 7. Compared with the creatinine level (AUROC=0.83, 95%CI: 0.68-0.97) of NGAL concentration (AUROC=0.80, 95%CI: 0.64-0.97) on the third day of admission, the former had a predictive effect on whether patients need CRRT with better specificity, but relatively low sensitivity.

Conclusion

The NGAL concentration on day 7 has a high predictive value for prognosis. Compared with creatinine, NGAL is more specific in predicting whether patients need CRRT.

Key words: Neutrophil gelatinase-associated apolipoprotein (NGAL), Sepsis, Septic shock, Biomarker, Prognosis

Jisong Zhang, Yuming Wang, Yanjun Zheng, Xing Qi, Peili Chen, Wen Shi, Ying Chen, Zhitao Yang, Enqiang Mao, Erzhen Chen. Predictive effect of neutrophil gelatinase-associated apolipoprotein (NGAL) on prognosis in patients with sepsis/septic shock[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2020, 06(04): 202-208.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwsyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9133.2020.04.002

https://zhwsyjdzzz.cma-cmc.com.cn/EN/Y2020/V06/I04/202

Figures/Tables 5

References 29

1	Singer M, Deutschman CS, Seymour CW, et al.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]．JAMA，2016，315(8):801-810.
2	Dellinger RP, Levy MM, Rhodes A, et al.Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012[J]．Intensive Care Med，2013，39(2):165-228.
3	马晓媛，田李星，梁华平．中西医结合诊治脓毒症的现状及思考[J/CD]．中华卫生应急电子杂志，2015，1(6):13-17.
4	申庆民，李文雄，赵松，等．持续静脉-静脉血液滤过治疗对早期严重脓毒症患者细胞免疫功能的影响[J/CD]．中华卫生应急电子杂志，2016，2(2):100-103.
5	于晶，谢晓华，张子敬．通腑泻热方治疗脓毒症的临床效果[J/CD]．中华卫生应急电子杂志，2015，1(5):41-44.
6	冯凯，郑燕华，杨鹤鸣，等．SAA与脓毒症进程的相关性及其生物学意义[J/CD]．中华卫生应急电子杂志，2018，4(5):290-297.
7	沈文明，岳茂兴，李瑛，等．动态监测创伤脓毒症患者血浆中高迁移率族蛋白B1含量的意义[J/CD]．中华卫生应急电子杂志2015，1(6):28-30.
8	郑燕华，吴莹莹，冯凯，等．白介素-10家族成员IL-10、IL-22与脓毒症的关系[J/CD]．中华卫生应急电子杂志，2018，4(4):243.
9	孙志林，刘大东，王旭，等．血浆microRNA-130 a联合APACHE Ⅱ评分预测脓毒症伴血小板减少患者死亡的巢式病例对照[J/CD]．中华卫生应急电子杂志，2019，5(6):325-329.
10	Vanlaere I, Libert C．Matrix metalloproteinases as drug targets in infections caused by gram-negative bacteria and in septic shock[J]．Clin Microbiol Rev，2009，22(2):224-239.
11	Haase M, Devarajan P, Haase-Fielitz A，et al.The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies[J]．J Am Coll Cardiol，2011，57(17):1752-1761.
12	Cohen J, Vincent JL, Adhikari NK，et al.Sepsis: a roadmap for future research[J]．Lancet Infect Dis，2015，15(5):581-614.
13	Rittirsch D, Flierl MA, Ward PA.Harmful molecular mechanisms in sepsis[J]．Nat Rev Immunol，2008，8(10):776-787.
14	于中锴，张宗旺，管向东．脓毒症的研究进展[J/CD]．中华卫生应急电子杂志，2019，5(2):59-62.
15	Lelubre C, Anselin S, Zouaoui Boudjeltia K，et al.Interpretation of C-reactive protein concentrations in critically ill patients[J]．Biomed Res Int，2013，(2013):124021.
16	van Engelen TSR, Wiersinga WJ, Scicluna BP，et al.Biomarkers in Sepsis[J]．Crit Care Clin，2018，34(1):139-152.
17	Mikkelsen ME, Miltiades AN, Gaieski DF，et al.Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock[J]. Crit Care Med，2009，37(5):1670-1677.
18	Chang W, Zhu S, Pan C，et al.Predictive utilities of neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis[J]．Clin Chim Acta，2018，(481):200-206.
19	Grützner F, Rens W, Tsend-Ayush E，et al.In the platypus a meiotic chain of ten sex chromosomes shares genes with the bird Z and mammal X chromosomes[J]．Nature，2004，432(7019):913-917.
20	Haase M, Bellomo R, Devarajan P，et al.Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis[J]．Am J Kidney Dis，2009，54(6):1012-1024.
21	Bagshaw SM, Bennett M, Devarajan P，et al.Urine biochemistry in septic and non-septic acute kidney injury: a prospective observational study[J]．J Crit Care，2013，28(4):371-378.
22	Schmidt-Ott KM, Mori K, Li JY，et al.Dual action of neutrophil gelatinase-associated lipocalin[J]．J Am Soc Nephrol，2007，18(2):407-413.
23	Mårtensson J, Bell M, Xu S，et al.Association of plasma neutrophil gelatinase-associated lipocalin (NGAL) with sepsis and acute kidney dysfunction[J]．Biomarkers，2013，18(4):349-356.
24	Wang M, Zhang Q, Zhao X，et al.Diagnostic and prognostic value of neutrophil gelatinase-associated lipocalin，matrix metalloproteinase-9，and tissue inhibitor of matrix metalloproteinases-1 for sepsis in the Emergency Department: an observational study[J]．Crit Care，2014，18(6):634.
25	Smertka M, Wroblewska J, Suchojad A，et al.Serum and urinary NGAL in septic newborns[J]．Biomed Res Int，2014，(2014):717318.
26	Kim H, Hur M, Lee S，et al.Proenkephalin，neutrophil gelatinase-associated lipocalin，and estimated glomerular filtration rates in patients with sepsis[J]．Ann Lab Med，2017，37(5):388-397.
27	Wang B, Chen G, Zhang J，et al.Increased neutrophil gelatinase-associated lipocalin is associated with mortality and multiple organ dysfunction syndrome in severe sepsis and septic shock[J]．Shock，2015，44(3):234-238.
28	Macdonald SPJ, Bosio E, Neil C，et al.Resistin and NGAL are associated with inflammatory response，endothelial activation and clinical outcomes in sepsis[J]．Inflamm Res，2017，66(7):611-619.
29	Shapiro NI, Trzeciak S, Hollander JE，et al.The diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin in the prediction of acute kidney injury in emergency department patients with suspected sepsis[J]．Ann Emerg Med，2010，56(1):52-59.e1.

组别	例数	性别		年龄(岁，±s)	BMI(±s)	疾病类型		APACHⅡ评分(分，±s)	C-反应蛋白(mg/L, ±s)	降钙素原[ng/mL，M(QR)]	肌酐[μmol/L，M(QR)]	乳酸(mmol/L，±s)]
组别	例数	男	女	年龄(岁，±s)	BMI(±s)	脓毒性休克	脓毒症	APACHⅡ评分(分，±s)	C-反应蛋白(mg/L, ±s)	降钙素原[ng/mL，M(QR)]	肌酐[μmol/L，M(QR)]	乳酸(mmol/L，±s)]
生存组	62	39(62.9)	23(37.1)	55.0±17.3	23.6±4.0	14(22.6%)	48(77.4%)	8.6±4.6	116.9±81.9	1.7(23.1)	74.0(115.5)	1.8±0.9
死亡组	22	14(63.6)	8(36.4)	60.5±18.5	24.5±4.2	10(45.5%)	12(54.5%)	12.0±4.6	119.2±76.5	3.0(24.6)	166.0(288.0)	2.7±2.6
t/χ²/U值	?	0.004		?	0.004	4.2		?	?	?	?	?
P值	?	>0.05		>0.05	>0.05	<0.05		<0.05	>0.05	>0.05	<0.05	<0.05
组别	例数	感染来源									SOFA评分[分，M(Q_R)]	白细胞(×10⁹/L，±s)
组别	例数	肠道	肺脏	泌尿系统	心脏	中枢神经	腹腔	皮肤/软组织	血流	不明部位	SOFA评分[分，M(Q_R)]	白细胞(×10⁹/L，±s)
生存组	62	3(4.8)	26(41.9)	5(8.1)	1(1.6)	1(1.6)	20(32.3)	5(8.1)	0(0)	1(1.6)	4(3)	13.1±6.2
死亡组	22	2(9.1)	12(54.5)	2(9.1)	0(0)	0(0)	4(18.2)	0(0)	1(4.5)	1(4.5)	6(6)	8.1±4.7
t/χ²/U值	?	0.04	1.0	0.02	0.6	0.6	1.0	3.1	2.7	0.5	?	?
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05
组别	例数	红细胞比容(%，±s)	血小板(×10³/μL，±s)	肌钙蛋白I[μg/L，M(Q_R)]	B型氨基端利钠肽原(IU/L, ±s)	行机械通气	行CRRT	使用血管活性药物	住院时间[d，M(Q_R)]	ICU时间[d，M(Q_R)]
生存组	62	34.6±7.2	197.2±106.7	0.9±2.2	2 377.2±2 626.3	16(25.8)	8(12.9)	8(12.9)	29(28)	17(22)
死亡组	22	28.9±7.0	167.6±149.2	0.9±1.2	3 507.8±3 517.2	19(86.4)	7(31.8)	15(68.2)	13(22)	10(16)
t/χ²/U值	?	22.1	4.0	25.0	?	?	?	?	?	?
P值	?	<0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	>0.05

组别	例数	性别		年龄(岁，±s)	BMI(±s)	疾病类型		APACHⅡ评分(分，±s)	C-反应蛋白(mg/L, ±s)	降钙素原[ng/mL，M(QR)]	肌酐[μmol/L，M(QR)]	乳酸(mmol/L，±s)]
组别	例数	男	女	年龄(岁，±s)	BMI(±s)	脓毒性休克	脓毒症	APACHⅡ评分(分，±s)	C-反应蛋白(mg/L, ±s)	降钙素原[ng/mL，M(QR)]	肌酐[μmol/L，M(QR)]	乳酸(mmol/L，±s)]
生存组	62	39(62.9)	23(37.1)	55.0±17.3	23.6±4.0	14(22.6%)	48(77.4%)	8.6±4.6	116.9±81.9	1.7(23.1)	74.0(115.5)	1.8±0.9
死亡组	22	14(63.6)	8(36.4)	60.5±18.5	24.5±4.2	10(45.5%)	12(54.5%)	12.0±4.6	119.2±76.5	3.0(24.6)	166.0(288.0)	2.7±2.6
t/χ²/U值	?	0.004		?	0.004	4.2		?	?	?	?	?
P值	?	>0.05		>0.05	>0.05	<0.05		<0.05	>0.05	>0.05	<0.05	<0.05
组别	例数	感染来源									SOFA评分[分，M(Q_R)]	白细胞(×10⁹/L，±s)
组别	例数	肠道	肺脏	泌尿系统	心脏	中枢神经	腹腔	皮肤/软组织	血流	不明部位	SOFA评分[分，M(Q_R)]	白细胞(×10⁹/L，±s)
生存组	62	3(4.8)	26(41.9)	5(8.1)	1(1.6)	1(1.6)	20(32.3)	5(8.1)	0(0)	1(1.6)	4(3)	13.1±6.2
死亡组	22	2(9.1)	12(54.5)	2(9.1)	0(0)	0(0)	4(18.2)	0(0)	1(4.5)	1(4.5)	6(6)	8.1±4.7
t/χ²/U值	?	0.04	1.0	0.02	0.6	0.6	1.0	3.1	2.7	0.5	?	?
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05
组别	例数	红细胞比容(%，±s)	血小板(×10³/μL，±s)	肌钙蛋白I[μg/L，M(Q_R)]	B型氨基端利钠肽原(IU/L, ±s)	行机械通气	行CRRT	使用血管活性药物	住院时间[d，M(Q_R)]	ICU时间[d，M(Q_R)]
生存组	62	34.6±7.2	197.2±106.7	0.9±2.2	2 377.2±2 626.3	16(25.8)	8(12.9)	8(12.9)	29(28)	17(22)
死亡组	22	28.9±7.0	167.6±149.2	0.9±1.2	3 507.8±3 517.2	19(86.4)	7(31.8)	15(68.2)	13(22)	10(16)
t/χ²/U值	?	22.1	4.0	25.0	?	?	?	?	?	?
P值	?	<0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	>0.05

[1]	Kang Ying, Canying Yang, Fengzhen Liu, Lili Chen, Yanna Liu. Prognostic value of left ventricular myocardial strain in asymptomatic patients with severe aortic stenosis [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 581-587.
[2]	Siping Zhang, Wei Liu, Pengcheng Ma. Therapeutic effects of lower extremity mild varus alignment after total knee arthroplasty [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 808-817.
[3]	Yuezhou Li, Kongxi Zhang, Xiaohong Li, Zhonghua Shang. Prognostic significance of PUM in gastric carcinoma based on bioinformatics analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 426-432.
[4]	Jun Zhang, Zai Luo, Mingyu Duan, Zhengjun Qiu, Chen Huang. Research progress of prognostic prediction models for gastric cancer [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 456-461.
[5]	Qian Yang, Cuifang Li, Wanqiu Zhang. Analysis of short-term and long-term prognosis and influencing factors of primary liver cancer with spontaneous ruptured hemorrhage after emergency TACE surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 33-36.
[6]	Yansong Li, Huimin Feng, Mingchao Liu, Zepeng Liu, Qiuxia Jiang. Expression and clinical significance of STIP1 in triple negative breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 52-56.
[7]	Xiaodan Wang, Yuan Wang, Xiangyu Cui, Xiaolei Ren. Analysis of pathogenic bacteria resistance of drug and high risk factors of death in urogenic sepsis after endoscopic surgery for upper urinary tract stones [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 611-615.
[8]	Ming Jiang, Rui Luo, Chengchao Long. Diagnosis and treatment of obturator hernia: An experience of 73 cases over 10 years [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 706-710.
[9]	Yanjun Lu, Jian Ma, Pengyu Bai, Linghong Guo, Haiyi Liu, Bo Jiang, Wenqi Bai, Yixun Zhang. Clinical effect of Nano-carbon on 253 groups of lymph node dissection in laparoscopic radical resection of rectal cancer [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 473-477.
[10]	Guangjun Zhong, Chunhua Liu, Wansen Zhu, Xiaolei Xu, Zhaojun Wang. Application of conventional MRI combined with different scanning sequences in preoperative staging diagnosis, chemotherapy efficacy and prognosis evaluation of gastric cancer [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 378-382.
[11]	Rongju Wu, Pingchao Xiang. Correlation between frequent exacerbation phenotype of chronic obstructive pulmonary disease and inflammatory markers [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 939-947.
[12]	Yongsheng Li, Jiahe Sun, Shuwei Guo, Yikang Lu, Hongzhou Liu. Short-term postoperative complications and their influencing factors in elderly patients with colorectal cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 962-967.
[13]	Jun Wang, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Libin Suo, Jun Chen, chengli Miao, Chenghua Luo. Retrospective analysis of anesthesia management of massive transfusion patients undergoing retroperitoneal tumor resection [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 844-849.
[14]	Libin Suo, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Jun Wang, Jun Chen, Chengli Miao, Chenghua Luo. Key points of anesthesia management and prognostic factors in patients undergoing primary retroperitoneal paraganglioma resection [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 771-776.
[15]	Rui Tan, Jing Wang, Jiangquan Yu, Ruiqiang Zheng. Progress in understanding of role of high density lipoprotein, apolipoprotein A-I, and serum amyloid A in sepsis [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 749-753.

Please choose a citation manager

Content to export