Uji Validitas Neutrophil Gelatinase Associated Lipocalin sebagai Penanda Diagnosis Gangguan Ginjal Akut pada Sepsis

Abstract

Gangguan ginjal akut (GgGA) merupakan penurunan fungsi ginjal secara mendadak yang ditandai dengan peningkatan kreatinin serum ≥0,3 mg/dL atau meningkat >1,5 kali dari kadar sebelumnya atau penurunan urine output (UO) <0,5 mL per jam selama >6 jam. Sepsis merupakan penyebab tersering GgGA dengan angka kejadian berkisar 20–50% dan angka kematian mendekati 70%. Kadar neutrophil gelatinase associated lipocalin (NGAL) urine penderita GgGA dapat meningkat secara cepat dan lebih awal dibandingkan dengan kadar kreatinin serum sehingga NGAL dapat dijadikan penanda diagnosis GgGA. Penelitian bertujuan mengetahui validitas NGAL urine sebagai penanda diagnosis GgGA pada penderita sepsis. Sebanyak 50 sampel urine diambil dari penderita sepsis di Unit Gawat Darurat (UGD), Intensive Care Unit (ICU), dan Medical Intermediate Care (MIC) di Rumah Sakit Dr. Hasan Sadikin Bandung selama Februari sampai Mei 2010 dan dilakukan pemeriksaan kadar NGAL urine dengan metode enzyme linked immunosorbent assay (ELISA). Data yang diperoleh dianalisis dengan uji nonparametrik Mann-Whitney, kurva receiver operating characteristic (ROC), dan uji validitas. Hasil penelitian didapatkan kadar NGAL urine penderita sepsis dengan GgGA lebih tinggi secara bermakna dibandingkan dengan penderita sepsis tanpa GgGA (3.380 ng/mL berbanding 116 ng/mL; p<0,001). Pada cut-off point 107 ng/mL, NGAL urine memiliki sensitivitas 100%, spesifisitas 36%, positive predictive value (PPV) 60,9%, negative predictive value (NPV) 100%, dan akurasi 68%. Simpulan, kadar NGAL urine memiliki validitas yang baik dan dapat dijadikan sebagai penanda diagnosis terjadinya GgGA pada penderita sepsis. [MKB. 2012;44(2):121–6].

Validity Test of Neutrophil Gelatinase Associated Lipocalin as Diagnostic Marker forAcute Kidney Injury on Sepsis

Acute kidney injury (AKI) is an abrupt decrease of renal function which marked by increase of serum creatinine ≥0.3 mg/dL or ≥1.5 times of previous level or decrease urine output <0.5 mL/hour in >6 hours. Sepsis is the most common cause of AKI with incidence rate is about 20–50% and mortality nearly 70%. Urine neutrophil gelatinaseassociated lipocalin (NGAL) level in AKI patients can increase quickly and earlier compared with serum creatinine and could be as a marker for AKI. The purpose of this study was to assess the validity of urine NGAL as diagnostic marker of AKI on sepsis patients. Subjects were 50 urine samples of sepsis patients from Emergency Department (ED), Intensive Care Unit (ICU) and Medical Intermediate Care (MIC) in Dr. Hasan Sadikin Hospital Bandung between February and May 2010 and were examined with enzyme linked immunosorbent assay (ELISA) method. Data analysis was performed by non parametric Mann-Whitney test, receiver operating characteristic (ROC) analysis and validity test.The results found that urine NGAL of AKI patients were significantly higher compared with non AKI patients (3,380 ng/mL vs 116 ng/mL, p<0.001). A cut-off point >107 ng/mL for urine NGAL had a sensitivity of 100%, specificity of 36%, positive predictive value (PPV) of 60.9%, negative predictive value (NPV) of 100% and accuracy of 68%. In conclusions, urinary NGAL level has good validity and could be used as a screening test for AKI on sepsis patients. [MKB. 2012;44(2):121–6].

DOI: http://dx.doi.org/10.15395/mkb.v44n2.131