The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.
The role of cerebrospinal fluid levels of neutrophil gelatinase-associated lipocalin (NGAL) and electroencephalography in the assessment of impaired consciousness in the context of infection
Open accessAbstract
Introduction: The sepsis syndrome is potentially affecting several organs and systems irrespectively of the primary source of the infection. Alterations of the brain function in sepsis patients may result either from a primary central nervous system (CNS) infection or could be part of the sepsis-associated encephalopathy (SAE), a common complication of sepsis, characterized by a diffuse dysfunction of the brain due to an infection elsewhere in the body without overt CNS infection. Aim of the study was to evaluate the usefulness of electroencephalography and the biomarker neutrophil gelatinase-associated lipocalin (NGAL) when measured in the cerebrospinal fluid (CSF) in the management of these patients. Methods: Patients presenting at the emergency department with altered mental status and signs of infection were included in this study. Among initial assessment and treatment of the patients based on the international guidelines for treating sepsis, NGAL was measured in the cerebrospinal fluid (CSF) using ELISA technique. Electroencephalography was performed when possible within 24 hours after admission and EEG abnormalities were recorded. Results: 32 of 64 patients included in this study were diagnosed with central nervous system (CNS) infection. CSF NGAL was significantly higher in patients with CNS infection compared to patients without CNS infection (18.1 [5.1–71.1] vs 3.6 [1.2–11.6]; p<0.001). There was a trend for higher CSF NGAL in patients with EEG abnormalities, which did not reach statistical significance (p=0.106). CSF NGAL levels were similar between survivors and non-survivors (medians: 7.04 vs 11.79). Conclusion: In patients presenting at the emergency department with altered mental status and signs of infection, CSF NGAL was significantly higher in patients with CSF infection. Its role in this acute setting should be evaluated further. CSF NGAL could be suggestive of EEG abnormalities.
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Cerebrospinal fluid NGAL can serve as a diagnostic biomarker for SAE.
“Clinical studies confirm that cerebrospinal fluid NGAL can serve as a diagnostic biomarker for SAE [42].”
From Research Advances in the Pathogenesis of Sepsis-Associated Encephalopathy (2026) · cites this paper as [42]
The CNS Infection results report diagnostic accuracy for identifying CNS infection, and the Discussion likewise describes CSF NGAL as a marker for CNS infection. The paper distinguishes SAE from infection within the CNS, but does not establish CSF NGAL as a diagnostic biomarker for SAE. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNGAL, S100β, and GFAP appear to show diagnostic promise for SAE.
“Third, biomarker availability: while NGAL, S100β, and GFAP appear to show diagnostic promise [42,88], none are validated for real-time monitoring.”
From Research Advances in the Pathogenesis of Sepsis-Associated Encephalopathy (2026) · cites this paper as [42]
The CNS Infection results and Discussion report diagnostic accuracy for CSF NGAL in distinguishing CNS infection from no CNS infection in patients with altered mental status and signs of infection. That offers limited support for NGAL's diagnostic promise in this setting, but the paper does not establish it as a diagnostic marker for SAE specifically, and the retrieved passages do not address S100β or GFAP. Page numbers were not available in our copy. (LLM, conf=0.84)
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Chakraborty, S., Kaur, S., Guha, S., & Batra, S. K. (2012) · Biochimica et Biophysica Acta (BBA) - Reviews on Cancer · doi:10.1016/j.bbcan.2012.03.008 · Cited by 503
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Research works printed but not linked: 6
- NASIOUDIS D, WITKIN SS. Neutrophil gelatinase-associated lipocalin and innate immune responses to bacterial infections. Med Microbiol Immunol. 2015 Aug;204(4):471–9. · DOI
- PANTZARIS ND, PLATANAKI C, TSIOTSIOS K, KONIARI I, VELISSARIS D. The Use of Electroencephalography in Patients with Sepsis: a Review of The Literature. J Transl Int Med. 2021 Jan 5;9(1):12–16. · DOI
- FLO TH, SMITH KD, SATO S, RODRIGUEZ DJ, HOLMES MA, STRONG RK, AKIRA S, ADEREM A. Lipocalin 2 mediates an innate immune response to bacterial infection by sequestrating iron. Nature. 2004;432:917–921. · DOI · Paper page
- ROUDKENAR MH, KUWAHARA Y, BABA T, ROUSHANDEH AM, EBISHIMA S, ABE S, OHKUBO Y, FUKUMOTO M. Oxidative stress induced lipocalin 2 gene expression: addressing its expression under the harmful conditions. J Radiat Res (Tokyo) 2007;48:39–44. · DOI
- OBREJA M, MIFTODE EG, STOLERIU I, CONSTANTINESCU D, VÂȚĂ A, LECA D, CIANGA CM, DORNEANU OS, PAVEL-TANASA M, CIANGA P.Heparin-Binding Protein (HBP), Neutrophil Gelatinase-Associated Lipocalin (NGAL) and S100 Calcium-Binding Protein B (S100B) Can Confirm Bacterial Meningitis and Inform Adequate Antibiotic Treatment. Antibiotics (Basel). 2022 Jun 19;11(6):824. · DOI
- LIPPI G, AVANZINI P, CALZETTI C, CALEFFI A, PIPITONE S, MUSA R, ALOE R, FERRARI C. The role of neutrophil gelatinase-associated lipocalin (NGAL) in cerebrospinal fluids for screening of acute bacterial meningitis. Clin Lab. 2014;60(3):377–81. · DOI
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Research Advances in the Pathogenesis of Sepsis-Associated Encephalopathy
Tan, H., Su, W., & Niu, Z. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27125390 · Cited by 1
Metadata
- Authors
- Platanaki, C., Paraskevas, T., Delastic, A.-L., Michailides, C., Kantanis, A., Polychronopoulos, P., Marangos, M., & Velissaris, D.
- Affiliations
- General University Hospital of Patras (GR)
- Department of Internal Medicine, Section of Infectious Diseases , University General Hospital of Patras , Greece
- Corresponding author
- Paraskevas, Themistoklis
- ORCID
- Venue
- Romanian Journal of Internal Medicine
- Publisher
- Walter de Gruyter GmbH
- Published
- 2023-05-08
- Volume
- 61
- Issue
- 2
- Pages
- 112-115
- ISSN
- 1220-4749 (ISSN-L)
- 2501-062X
- OpenAlex
- W4321327477
- Cited by
- 2
- References
- 1
- Citations by year
- 2025: 1 · 2023: 1
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Romanian Journal of Internal Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- neutrophil gelatinase-associated lipocalin, cerebrospinal fluid biomarkers, sepsis-associated encephalopathy, central nervous system infection, impaired consciousness, altered mental status, EEG abnormalities, sepsis
- MeSH terms
- Lipocalin-2, Consciousness Disorders, Electroencephalography, Humans, Biomarkers, Sepsis
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