This is very similar to the 150 ng/ml expressed in the literature [20].Using a cutoff of 150 ng/ml and two serial NGAL measurements (T0, T6), we could establish a NPV of 98% within 6 hours of the patient’s arrival. Enzalutamide purchase In the acute setting, the possibility of ruling out the occurrence of severe diseases such as AKI is of great importance [38,39,43,44]. On the other hand, NGAL value above cutoff of 400 ng/ml seems to be very specific for ruling on the diagnosis of AKI. Consequently, it appears that with NGAL, similar to the use of B-type natriuretic peptide (BNP) for diagnosis of heart failure [38] and for many other biomarkers, there could exist a grey zone where the clinical judgment coupled with biomarker assessment is crucial to the prompt and accurate diagnosis of AKI [45].

In our study, blood NGAL also demonstrated the ability to differentiate intrinsic AKI from other renal diseases/dysfunction at initial assessment. NGAL values were significantly higher in patients with AKI when compared to patients with renal dysfunction or stable CKD. These results are similar to the Nickolas studies on urinary NGAL [4]. From our results, blood NGAL value in this group of patients with renal dysfunction was significantly higher compared to patients with stable CKD and to patients with preserved renal function, a finding that is consistent with those of Singer et al .[38]. This allows clinicians to distinguish between chronic disease and early reversible kidney damage.

From our results it was evident that sCr was not able to distinguish this difference, since the value of sCr in this group with renal dysfunction was not increased at baseline evaluation compared to patients with stable CKD or with preserved renal function. From our data, NGAL could not only be considered a diagnostic marker but also a prognostic biomarker. Admission NGAL has been shown to be able to predict in-hospital mortality with a high OR (8.3) when a threshold of 400 ng/ml was used. Admission NGAL value above 400 ng/ml had a high AUC (0.76 +/- 0.11) for in-hospital mortality. The ability to predict which patients will likely need RRT and which have a high probability of in-hospital death has understated importance in resource utilization.ConclusionsIn summary, our study demonstrated that admission blood NGAL measurements are useful in the early diagnosis of AKI.

Baseline NGAL measurement allows detection of AKI earlier than sCr. Improved diagnostic performance was demonstrated when NGAL was combined with clinical judgment. NGAL is also able to distinguish intrinsic AKI from early reversible kidney dysfunction while sCr cannot.Blood NGAL levels detected development of acute renal injury at 6 hours, nearly 2 days earlier than sCr increases Brefeldin_A at 48 hours. Blood NGAL assessment at the moment of hospital admission from the ED predicted the combined outcome of RRT and in-hospital mortality.