The role of neutrophil gelatinase-associated lipocalin (NGAL) in the detection of blast lung injury in a military population

Purpose
To study the relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) and military blast and gunshot wound (GSW) to establish whether potential exists for NGAL as a biomarker for blast lung injury (BLI).

Method
Patients from the intensive care unit (ICU) of the Role 3 Medical Treatment Facility at Camp Bastion, Helmand Province, Afghanistan were studied over a five month period commencing in 2012. Age, mechanism, trauma injury severity score (TRISS) and serum NGAL were recorded on ICU admission (NGAL1). Serum NGAL (NGAL2) and PaO2/FiO2 ratio (P/F ratio2) were recorded at 24 h.

Results
33 patients were injured by blast and 23 by GSW. NGAL1 inversely correlated with TRISS (p = 0.020), pH (p = 0.002) and P/F ratio 2 (p = 0.009) overall. When data was stratified into blast and GSW, NGAL1 also inversely correlated with P/F ratio 2 in the blast injured group (p = 0.008) but not GSW group (p = 0.27).

Conclusion
Raised NGAL correlated with increased severity of injury (worse survival probability i.e. TRISS and low pH) in both patient groups. There was an inverse correlation between admission NGAL and a marker of blast lung injury (low P/F ratio) at 24 h in blast injured group but not GSW group that warrants further investigation.