Predicting the Initiation of Continuous Venovenous Hemofiltration in Acute Pancreatitis Patients: The Role of Plasma and Urinary Neutrophil Gelatinase-Associated Lipocalin

Background: Acute kidney injury (AKI) is a serious complication of acute pancreatitis and is frequently associated with the need for continuous renal replacement therapy. Early identification of patients at risk of requiring continuous venovenous hemofiltration (CVVHF) remains challenging because conventional renal markers often reflect delayed kidney injury. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a potential biomarker of early renal tubular damage. Methods: This observational study included 219 patients with acute pancreatitis. Plasma and urinary NGAL levels were measured at hospital admission. Clinical characteristics, laboratory parameters, and severity scores were compared between patients who required CVVHF and those who did not. Multivariate logistic regression analysis was performed to identify factors associated with CVVHF requirement, and predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: During hospitalization, 28 patients (12.8%) required CVVHF and had significantly more severe disease. Both plasma and urinary NGAL levels were higher in patients requiring CVVHF. In multivariate analysis, urinary NGAL remained independently associated with CVVHF requirement. ROC analysis demonstrated moderate predictive performance for urinary NGAL (AUC 0.708). Conclusions: Urinary NGAL was independently associated with the requirement for CVVHF and demonstrated moderate predictive performance. These findings suggest that urinary NGAL may provide kidney-specific information and improve early risk stratification beyond conventional clinical parameters.