Role of Neutrophil Gelatinase-associated Lipocalin (NGAL) and Other Clinical Parameters as Predictors of Bacterial Sepsis in Patients Presenting to the Emergency Department with Fever

• Authors: Anna Paul, Christian Medical College, Vellore; Nalini Sarah Newbigging, Christian Medical College, Vellore; Audrin Lenin, Christian Medical College, Vellore; Mahasampath Gowri, Christian Medical College, Vellore; Jithin Varghese, Emory University; Arun Jose Nell, Christian Medical College, Vellore; Kundavaram Paul Prabhkar Abhilash, Christian Medical College, Vellore; Aditya Jose Binu, Christian Medical College, Vellore; Vignesh Kumar Chandiraseharan, Christian Medical College, Vellore; Ramya Iyyadurai, Christian Medical College, Vellore; George M Varghese, Christian Medical College, Vellore
• Journal Title: Indian Journal of Critical Care Medicine
• Volume: Volume 27, Number 3
• Publisher: Indian Journal of Critical Care Medicine | 2023-03-01, Pages 176-182
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.5005/jp-journals-10071-24419
• Subjects: Health Sciences, Nutrition
• Keywords: Bacteremia; Biomarker; Emergency department; Neutrophil gelatinase-associated lipocalin; Sepsis; Systemic inflammatory Response Syndrome; quick sequential organ failure assessment

Abstract

Background: Bacterial sepsis is associated with significant morbidity and mortality. However, to date, there is no single test that predicts sepsis with reproducible results. We proposed that using a combination of clinical and laboratory parameters and a novel biomarker, plasma neutrophil gelatinase-associated lipocalin (NGAL) may aid in early diagnosis. Method: A prospective cohort study was conducted at a tertiary care center in South India (June 2017 to April 2018) on patients with acute febrile episodes fulfilling the Systemic Inflammatory Response Syndrome (SIRS) criteria. Plasma NGAL and standard clinical and laboratory parameters were collected at the admission. Bacterial sepsis was diagnosed based on blood culture positivity or clinical diagnosis. Clinically relevant plasma NGAL cut-off values were identified using the receive operating characteristic (ROC) curve. Clinically relevant clinical parameters along with plasma NGAL’s risk ratios estimated from the multivariable Poisson regression model were rounded and used as weights to create a new scoring tool. Results: Of 100 patients enrolled, 37 had bacterial sepsis. The optimal plasma NGAL cut-off value to predict sepsis was 570 ng/mL [area under the curve (AUC): 0.69]. The NGAL sepsis screening tool consists of the following clinical parameter: diabetes mellitus, the presence of rigors, quick sequential organ failure assessment (qSOFA) >2, a clear focus of infection, and the plasma NGAL >570 ng/mL. A score of <3 ruled out bacterial sepsis and a score >7 were highly suggestive of bacterial sepsis with an interval likelihood ratio (LR) of 7.77. Conclusion: The NGAL sepsis screening tool with a score >7 can be used in the emergency department (ED) to identify bacterial sepsis.