Impact of clinical context on acute kidney injury biomarker performances: differences between neutrophil gelatinase-associated lipocalin and L-type fatty acid-binding protein

Sci Rep. 2016 Sep 8:6:33077. doi: 10.1038/srep33077.


Application of acute kidney injury (AKI) biomarkers with consideration of nonrenal conditions and systemic severity has not been sufficiently determined. Herein, urinary neutrophil gelatinase-associated lipocalin (NGAL), L-type fatty acid-binding protein (L-FABP) and nonrenal disorders, including inflammation, hypoperfusion and liver dysfunction, were evaluated in 249 critically ill patients treated at our intensive care unit. Distinct characteristics of NGAL and L-FABP were revealed using principal component analysis: NGAL showed linear correlations with inflammatory markers (white blood cell count and C-reactive protein), whereas L-FABP showed linear correlations with hypoperfusion and hepatic injury markers (lactate, liver transaminases and bilirubin). We thus developed a new algorithm by combining urinary NGAL and L-FABP with stratification by the Acute Physiology and Chronic Health Evaluation score, presence of sepsis and blood lactate levels to improve their AKI predictive performance, which showed a significantly better area under the receiver operating characteristic curve [AUC-ROC 0.940; 95% confidential interval (CI) 0.793-0.985] than that under NGAL alone (AUC-ROC 0.858, 95% CI 0.741-0.927, P = 0.03) or L-FABP alone (AUC-ROC 0.837, 95% CI 0.697-0.920, P = 0.007) and indicated that nonrenal conditions and systemic severity should be considered for improved AKI prediction by NGAL and L-FABP as biomarkers.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / metabolism*
  • Aged
  • Area Under Curve
  • Biomarkers / blood*
  • Biomarkers / metabolism*
  • C-Reactive Protein / metabolism
  • Critical Illness
  • Fatty Acid-Binding Proteins / metabolism*
  • Female
  • Humans
  • Intensive Care Units
  • Lactic Acid / blood
  • Leukocyte Count / methods
  • Lipocalin-2 / metabolism*
  • Male
  • Middle Aged
  • Prospective Studies
  • ROC Curve
  • Sepsis / blood
  • Sepsis / metabolism


  • Biomarkers
  • FABP1 protein, human
  • Fatty Acid-Binding Proteins
  • LCN2 protein, human
  • Lipocalin-2
  • Lactic Acid
  • C-Reactive Protein