Use of admission serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations as a marker of sepsis and outcome in neonatal foals.
Authors: Laurberg Malene, Saegerman Claude, Jacobsen Stine, Berg Lise C, Laursen Sigrid Hyldahl, Hoeberg Emma, Sånge Elaine Alexandra, van Galen Gaby
Journal: PloS one
Summary
# Editorial Summary: NGAL as a Sepsis Marker in Neonatal Foals Differentiating septic from non-septic neonates remains one of the most pressing diagnostic challenges in equine practice, with significant implications for treatment decisions and prognosis. Researchers measured serum neutrophil gelatinase-associated lipocalin (NGAL)—a marker of renal inflammation—in 91 foals aged ≤14 days at admission, stratifying them by sepsis status and outcome, then used receiver operating characteristic curves to establish diagnostic thresholds and compare NGAL performance against established markers like serum amyloid A (SAA) and creatinine. Septic foals had significantly elevated NGAL concentrations compared with non-septic animals; critically, non-survivors displayed lower median NGAL levels than survivors, suggesting a complex relationship between this marker and prognosis. An admission NGAL threshold of 455 µg/L achieved 71.4% sensitivity and 100% specificity for sepsis diagnosis, whilst 1104 µg/L predicted non-survival with 39.3% sensitivity and 95.2% specificity, performing comparably to SAA in diagnostic utility. For practitioners, serum NGAL measurement at admission could enhance early sepsis identification and risk stratification in neonatal foals, though the counterintuitive finding that lower NGAL associates with mortality warrants further investigation and suggests NGAL should complement rather than replace existing diagnostic and prognostic protocols.
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Practical Takeaways
- •NGAL can be a useful supplementary biomarker for identifying sepsis in neonatal foals when traditional clinical signs are ambiguous, particularly with high specificity at 455 µg/L threshold
- •NGAL values above 1104 µg/L indicate poor prognosis and may help guide early decision-making about intensive care escalation or palliative care in septic foals
- •NGAL performs as well as SAA for sepsis diagnosis and offers another practical diagnostic option when evaluating sick neonatal foals
Key Findings
- •Serum NGAL concentrations were significantly higher in septic foals compared to non-septic foals
- •NGAL concentrations were significantly lower in surviving foals than non-surviving foals
- •Optimal cut-off value of 455 µg/L for NGAL achieves 71.4% sensitivity and 100% specificity for sepsis diagnosis
- •NGAL performed similarly to serum amyloid A (SAA) for sepsis diagnosis with cut-off of 1104 µg/L predicting non-survival (sensitivity 39.3%, specificity 95.2%)