Clinical significance of neutrophil gelatinase-associated lipocalin in patients with acute ischemic stroke

Abstract

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker for diagnosis and prognosis of acute kidney injury and it is also related with cardiovascular disease. However, the relationship between NGAL and ischemic stroke is not clearly defined. We measured serum NGAL in patients with acute ischemic stroke and evaluated the relationships with risk factors, stroke severity, outcomes, and other laboratory parameters. Methods:We retrospectively reviewed patients with transient ischemic attack or ischemic stroke. We recorded patient risk factors and laboratory test results at the time of admission and excluded patients with renal insufficiency to avoid potential effect of kidney function on NGAL concentration. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and outcome was evaluated using the modified Rankin Scale (mRS). Results:The median serum NGAL was 68 ng/mL (interquartile range 51-98). The patients in the high NGAL group were significantly older and had higher initial NIHSS score and 3 month mRS score than those in the low NGAL group. We observed significant correlations of NGAL with C-reactive protein, erythrocyte sedimentation rate, creatinine, blood urea nitrogen, fibrinogen, and homocysteine values. There were no significant differences in NGAL level between stroke subtypes. Logistic regression analysis revealed that NGAL concentrations were associated with poor outcome. Conclusions: Increased NGAL concentration in patients with acute ischemic stroke patients is associated with stroke severity and poor outcome. Further investigations are needed to determine the precise clinical significance of NGAL in ischemic stroke.