URINARY URIC ACID/CREATININE RATIO, Β2-MICROGLOBULIN AND NGAL AS MARKERS FOR HYPOXIC-ISCHEMIC ENCEPHALOPATHY IN NEONATES | ||||
| Al-Azhar Journal of Pediatrics | ||||
| Article 7, Volume 25, Issue 1, January 2022, Page 2483-2503 PDF (315.83 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/azjp.2022.247419 | ||||
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| Abstract | ||||
| Background: Hypoxic-ischemic encephalopathy (HIE) can develop due to perinatal asphyxia, and the brain is considered a highly susceptible organ. During the first 72 hours after a quick assessment, competent patients need neuroprotective medications to prevent brain harm. Consequently, the importance of investigating rapid, easily detected markers to help in early diagnosis with subsequent better prognosis. Objective: We intended to measure and compare the usefulness of urinary neutrophil gelatinase-associated lipocalin (NGAL), Beta 2-microglobulin (β2M), and uric acid creatinine ratio (U/Cr) as diagnostic and prognostic markers in HIE. Methods: This is a case-control study that was carried out during the period from September 2018 to September 2020 at the NICU of Menofia University Hospitals on 200 neonates who were selected by simple random method. Out of them, 100 patients had perinatal asphyxia complicated with HIE (cases) according to The American Academy Of Pediatrics and American College Of Obstetrics And Gynecology and another 100 healthy neonates as (control). Routine investigations, EEG and MRI, were performed for all cases. Urinary NGAL, β2M, and U/Cr ratios were measured for all studied neonates at admission and again at 48hs for cases. Results: Our study showed that urinary U/Cr ratio, β2M, and NGAL were significantly higher in neonates suffering from HIE than in controls (2.38 vs. 0.96, 2.73 vs. 1.37, and 42.5 vs. 13.5; all p < 0.001). Also, they were highly elevated in non–survivors compared to survivors and at admission compared to after 48 hs in survivors, while the opposite was the case in non-survivors, all p ≤ 0.001). Neonates classified as stage III Sarnat reported elevated levels of the tested markers compared to stage I and II. The diagnostic ROC curve analysis clarified that urinary NGAL had an excellent diagnostic presentation to detect HIE (AUC=.992, cuttoff= 22.50), while β2M had the best prognostic value (AUC=0.883, cuttoff=2.80) and uric acid /creatinine ratio was the best indicator of disease severity (AUC=0.90, cuttoff=2.20). Conclusion: Urinary U/Cr ratio, β2M and NGAL are promising, available, non- invasive, painless, and low-cost predictive and prognostic additional support in early diagnosis of HIE, with high sensitivity and specificity going to urinary NGAL for diagnosis, β2M for prognosis and uric acid /creatinine ratio for severity. | ||||
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