Neutrophil gelatinase-associated lipocalcin fails to predict AKI in critically ill obstetric ICU patients: Study

AKI frequently occurs among critically ill patients as a common morbidity. Recent research paper evaluates the incidence of acute kidney injury (AKI) in obstetric ICU patients and validates the role of urinary and serum NGAL in predicting AKI and mortality. The study aimed to assess the incidence of AKI in obstetric ICU patients and validate the role of urinary and serum NGAL in predicting the onset of AKI and mortality. The prospective observational cohort study included 45 obstetric patients admitted in ICU, and the occurrence of AKI, patient outcomes (survival or death), and serum and urinary NGAL were monitored.

The findings revealed that 71.1% of obstetric ICU patients experienced AKI during their ICU stay. Serum NGAL had a limited ability to predict AKI and ICU mortality, with an AUROC of 0.630 for AKI and 0.486 for ICU mortality. Similarly, urinary NGAL showed AUROC of 0.472 for predicting AKI and 0.430 for ICU mortality, indicating poor discriminatory ability for both outcomes. Despite the high incidence of AKI in critically ill obstetric patients, the study concluded that serum and urinary NGAL cannot effectively discriminate between patients with or without AKI, or between survivors and non‑survivors in this patient population.

The study also highlighted the common reasons for ICU admission, such as eclampsia/preeclampsia, maternal haemorrhage, and puerperal sepsis. The incidence of various risk factors known to be associated with AKI was assessed, and significantly higher incidence of sepsis was noted in those with AKI. Additionally, the study described the limitations such as inadequate powering for detecting the severity distribution of AKI and the inclusion of patients with varying severity of preeclampsia.

In conclusion, the study demonstrated that AKI is prevalent in critically ill obstetric ICU patients, with 71.1% of patients experiencing AKI during their ICU stay. However, serum and urinary NGAL measured at the time of ICU admission were found to be ineffective in discriminating between patients with or without AKI, and between survivors and non‑survivors in this patient population. The study addresses the scarcity of data focusing on AKI in obstetric patients admitted to the ICU and emphasizes the limited role of NGAL in predicting AKI and mortality in this specific patient population.

Key Points

- Incidence of acute kidney injury (AKI) was evaluated in 45 obstetric ICU patients. 71.1% of patients experienced AKI during their ICU stay.

- The study aimed to validate the role of urinary and serum NGAL in predicting AKI and mortality. Serum NGAL had limited ability to predict AKI and ICU mortality, with AUROC of 0.630 for AKI and 0.486 for ICU mortality. Urinary NGAL also showed poor discriminatory ability for both outcomes, with AUROC of 0.472 for predicting AKI and 0.430 for ICU mortality.

- Common reasons for ICU admission included eclampsia/preeclampsia, maternal haemorrhage, and puerperal sepsis. Higher incidence of sepsis was noted in those with AKI.

- The study demonstrated the limitations of NGAL in discriminating between patients with or without AKI, and between survivors and non‑survivors in this patient population.

- The study concludes that AKI is prevalent in critically ill obstetric ICU patients, but serum and urinary NGAL were found to be ineffective in predicting AKI and mortality in this specific patient population.

- The research addresses the scarcity of data on AKI in obstetric patients and emphasizes the limited role of NGAL in predicting AKI and mortality in this specific patient population.

Reference –

Pipil K, Tyagi A, Tyagi S, Nigam C, Das S. Acute kidney injury in critically ill obstetric patients: Incidence and role of neutrophil gelatinase‑associated lipocalcin – A prospective observational cohort study. Indian J Anaesth 2024;68:680‑5.