Neutrophil gelatinase-associated lipocalin: An early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis.

Background And Aim: Acute kidney injury (AKI) in severe acute pancreatitis (SAP) has a high mortality rate. Traditionally used serum creatinine is an insensitive biomarker for the early detection of AKI. We aimed to study the role of plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL) in predicting AKI and a severe course in patients with acute pancreatitis (AP).

Methods: Consecutive patients of AP who presented within 72 h of symptom onset and age- and gender-matched healthy controls were included. Urinary and serum NGAL levels [enzyme-linked immunosorbent assay (ELISA)] were evaluated within 24 h of and 72 h after admission and once in controls. Urine and serum NGAL levels were correlated with development of AKI, severity, and outcomes of AP.

Results: Fifty patients with AP and 30 controls were enrolled. The mean serum and urine NGAL levels in patients on day 1 were significantly higher than the serum and urine NGAL levels in controls ( < 0.001). After excluding patients with AKI on day 1 ( = 10), both serum and urinary NGAL levels on days 1 and 3 were significantly higher in patients who subsequently developed AKI ( = 11) compared to those who did not ( = 29) ( = 0.02, 0.01 and  < 0.001, 0.03). A urinary NGAL level of 221.03 ng/mL on day 1 predicted AKI with a sensitivity and specificity of 82 and 80%, respectively (AUC = 0.9). Mean serum and urinary NGAL levels on day 1 were significantly elevated in patients with SAP compared to those without SAP ( = 0.04 and <0.001).

Conclusion: NGAL levels in urine and serum can predict severity of AP and development of AKI.