Can Serum NGAL Levels be Used as an Early Prognostic Marker to Predict the Need for Intensive Care in COVID-19?

Introduction: It is important to determine which patients admitted to the hospital with COVID-19 should be hospitalized and treated. In this study, the aim was to investigate whether serum neutrophil gelatinase-associated lipocalin (NGAL) levels in the early period are related to the need for intensive care follow-up in COVID-19.

Methods: A total of 91 patients with a definite diagnosis of COVID-19 were included in the study. Patients hospitalized in the internal medicine clinic were screened cross-sectionally, and eligible patients were included in the study. Patients were divided into groups as mild/moderate pneumonia and severe pneumonia. Serum NGAL levels were measured before pulse steroid therapy. Age, gender, comorbid diseases, and 1-month survival of the patients were recorded.

Results: In patients requiring pulse steroid therapy compared to those who did not, there was a significant difference between the median serum NGAL levels. The median NGAL level showed a significant difference in patients requiring intensive care treatment compared to patients hospitalized in the inpatient service. Receiver operating characteristic curve analysis showed the relationship between serum NGAL levels and the need for treatment in the intensive care unit. It was also observed that the need for admittance to the intensive care unit was 10.9 times higher in those with a serum NGAL level below 30.29, according to the multivariate analysis. There was a significant difference between the median NGAL levels of patients who survived and those who died.

Discussion and Conclusion: This study found a significant difference between serum NGAL levels of patients who died, who required intensive care follow-up, and who needed pulse steroid therapy.

Keywords: COVID-19; Intensive care; Lipocalin-2; NGAL