الفهرس 
INTRODUCTION & AIM OF WORKOnly 14 pages are availabe for public view
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Abstract
This study aimed to evaluate the role of serum neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for acute kidney injury (AKI) in children with septicemia. This study included 68 children with septicemia (38 patients with sepsis and 30 patients with septic shock) and 20 healthy children as a control group. Out of these 68 patients, 32(47%) were diagnosed as acute kidney injury.
The commonest causes of septicemia in this study were gastroenteritis [48%] and pneumonia [27.9%].
The commonest organisms responsible for septicemia in this study were Gram positive cocci [51.4%] followed by Gram negative bacilli [35.2%]. The most common organism responsible for septicemia in the studied cases was staphylococcus Aureus.
In the present study about 47% of cases have AKI according to the KDIGO staging. About 13.24% of the patients have hypervolemia and 2 patients (2.94%) have pulmonary oedema as complications in the studied cases with septicemia.
The severity of sepsis increased the incidence of AKI and this clear in this study where incidence of AKI in patients with sepsis only was 29% and the incidence increased greatly in patients with septic shock [70%].
In addition, there is an association between the increasing severity of sepsis and the severity of AKI. In our study, most of patients with sepsis associated AKI are KDIGO stage1 (71%) while most of the patients with septic shock associated AKI are KDIGO stage2&3(30%& 36%). Other features of severity of AKI like oliguria and hypervolemia are more prevalent in patients with septic shock associated AKI when compared to patients with sepsis associated AKI in our study.
Our study shows that patients with AKI were younger than those without AKI. They also had significantly higher frequencies of septic shock, and higher needs for vasopressor support and mechanical ventilation. Critically ill patients with AKI tended to have higher PRISM scores than those without AKI.
When the KDIGO staging system was applied to the present study, we found totally 32(47%) patients having AKI [8 patients (11.76%) had stage 1; 13(19.12%) stage 2, and 11 (16.18%) had stage 3].
As regard to severity of AKI, we found the overall mortality rate 33.82% in our study and we found that septic patients with AKI had higher PRISM score [20 vs.9] and higher mortality rate [62% vs.8%] when compared to septic patients without AKI. We also found that patients who developed AKI stage3 had the highest PRISM score and mortality.
In this study, we evaluated serum NGAL as a biomarker of sepsis and as a specific predictor for AKI in septic children. We found that, serum NGAL was significantly increased in critically ill children with different grades of sepsis (severe sepsis and septic shock) compared to healthy controls. Also, serum NGAL in critically ill children with septic shock was significantly higher than in critically ill children with sepsis, reflecting the severity of illness in those patients.
In our study, ROC analysis showed that serum NGAL had a poor sensitivity with poor specificity for prediction of AKI, and their ability to predict AKI in patients with septic shock was poor with an AUC-ROC =0.56. Meanwhile, ROC analysis of serum creatinine in our study showed a higher sensitivity and higher specificity for prediction of AKI, so serum creatinine has better ability to predict AKI in septic patients.
AKI had a major impact on prognosis in critically ill children. Predictors of mortality in the current study were septic shock, oliguria, hypervolemia, severity of AKI, mechanical ventilation, need for RRT and PRISM score.
The present study has multiple limitations. Precise measurements of urine output were not done and the diagnosis of AKI was based only on levels of serum creatinine, this might have resulted in underreporting of the incidence of AKI. Secondly, this study was performed at a single center, on patients who were sicker.
Conclusions:
1- In the present study, serum Neutrophil Gelatinase –Associated Lipocalin was significantly elevated in critically ill children with septicemia however no significant difference was found in septic children with or without acute kidney injury.
2- Serum Neutrophil Gelatinase –Associated Lipocalin was less sensitive than serum creatinine in diagnosis of acute kidney injury in critically ill septic children.
3- Further studies using larger number of children are needed.