Early Detection of Acute Kidney Injury in Sepsis

Abstract

Background: Acute kidney injury (AKI) is a critical complication in septic patients admitted to intensive care units (ICUs), often leading to increased morbidity and mortality. This study aimed to evaluate the incidence, clinical characteristics, and outcomes of AKI in septic patients and assess the predictive value of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in early AKI detection.

Methods: Thirty-five adult patients diagnosed with sepsis upon ICU admission were prospectively enrolled. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographic, clinical, and laboratory data—including serum creatinine, NGAL, lactate, CRP, and procalcitonin levels—were collected. NGAL levels were measured on Days 1, 3, 5, and 7, and statistical analyses were performed using SPSS version 26. Statistical analysis was performed using SPSS version 26, with p-values < 0.05 considered significant.

Results: Among the studied cohort, 40% were smokers, and hypertension (51.4%) was the most common comorbidity. The incidence of AKI in septic patients was 40% (n=14). The AKI group had significantly higher serum creatinine (4.5 ± 1.2 mg/dL vs. 1.4 ± 0.6 mg/dL, p<0.001), NGAL levels (160 ± 40 ng/mL vs. 100 ± 30 ng/mL, p<0.001), and lactate levels (4.0 ± 1.2 mmol/L vs. 2.5 ± 0.8 mmol/L, p=0.001) compared to the non-AKI group. ICU mortality was significantly higher in the AKI group (42.9%) than in non-AKI patients (19%, p=0.05). The NGAL cutoff at >100 ng/mL had 100% sensitivity but lower specificity (40.9%), while a cutoff at >200 ng/mL had 61.5% sensitivity and 100% specificity for AKI prediction.

Conclusion: AKI is a frequent and severe complication in septic ICU patients, associated with increased mortality and a higher risk of chronic kidney disease progression. NGAL is a promising biomarker for early AKI detection, with high sensitivity at lower cutoff values and improved specificity at higher thresholds. Early recognition and management of AKI in septic patients are crucial to improving outcomes.