Predictive utilities of neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis

We aim to investigate the predictive value of plasma neutrophil gelatinase-associated lipocalin (pNGAL) in patients with severe sepsis. A total of 124 patients were enrolled in this observational study. Blood samples were obtained at admission, on day 2 and day 7. Receiver operating characteristic (ROC) curves were generated to assess the utility of pNGAL in prediction of 28-day mortality and need for CRRT. Cox regression curves were built with and without pNGAL for 28-day mortality prediction to determine NGAL's contributive predictive value. Plasma NGAL was significantly increased in non-survivors group on day 2 and 7 and predicted 28-day mortality with AuROC values of 0.675 (95% CI 0.570–0.780) and 0.752 (95% CI 0.619–0.885). Addition of day 2 NGAL to the clinical model resulted in a net reclassification index (NRI) increment of 0.40 (95% CI 0.06–0.75, P = 0.028) for prediction of 28-day mortality. The AuROC of NGAL at admission and day 2 was greater than creatinine in prediction of the need for CRRT. Plasma NGAL discriminated 28-day survivors from non-survivors on day 2 and 7 and was a relatively robust predictor of 28-day mortality prediction. Plasma NGAL possibly outperformed creatinine in the prediction of need for CRRT. •Plasma NGAL on day 2, rather than at admission was a relatively robust predictor in 28-day mortality in severe sepsis.•NGAL maybe out-performed serum creatinine in prediction of the need of CRRT in severe sepsis.•NRI analysis demonstrated the added predictive value in 28-day mortality of NGAL as a biomarker (NRI = 0.40, P = 0.028).