NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN AS A MARKER OF NEUTROPHILIC INFLAMMATION PATTERN IN UNCONTROLLED CHILDHOOD ASTHMA

Аsthma remains one of the most common chronic respiratory diseases in children, with about half of children with asthma experiencing uncontrolled disease progression. Markers of the eosinophilic endotype of asthma are well studied, but the neutrophilic endotype, especially in children, has not been sufficiently researched, and reliable serum/plasma markers of the neutrophilic pattern of inflammation in asthma are unknown. Objective: To determine the diagnostic significance of plasma concentrations of neutrophil gelatinase-associated lipocalin (NGAL) in relation to asthma control in children. Materials and methods: 132 children with asthma aged 6-17 years (mean age 12.5±3.5 years; 81 boys/51 girls) were examined. The degree of asthma control was assessed using the Asthma Control Test questionnaire. The following groups were identified: controlled asthma (n=21), partially controlled asthma (n=47), and uncontrolled asthma (n=64). NGAL concentration in blood plasma was determined using an automated immunoassay. Statistical analysis included the Kruskal-Wallis test, Mann-Whitney U test, Spearman's correlation analysis, and ordinal logistic regression. Results: In children with uncontrolled asthma, NGAL levels were statistically significantly higher compared to the controlled and partially controlled asthma groups (p=0.043). NGAL correlated positively with the absolute number of peripheral blood neutrophils (r=0.272; p<0.001) and showed no association with markers of eosinophilic asthma endotype (total IgE, eosinophils). At the same time, we did not find any differences in NGAL concentration depending on the asthma severity (Kruskal-Wallis test p = 0.420) and the phase of the disease (remission (n = 46) – 103 (63-185) ng/ml, exacerbation against the background of viral infection (n = 14) – 105 (66.8-156) ng/mL, exacerbation without signs of viral infection (n = 72) – 138 (90.5-207) ng/mL; Kruskal-Wallis test p = 0.310). Ordinal logistic regression showed that an increase in NGAL by every 10 ng/ml increases the likelihood of worsening asthma control by 5% (OR=1.05; 95% CI: 1.01-1.09; p=0.022) regardless of gender, age, and disease severity. Conclusion: Plasma NGAL concentration is an independent biomarker of uncontrolled asthma in children, reflecting a predominantly neutrophilic inflammation pattern. NGAL may be used as a screening tool for the early identification of children at risk of losing asthma control and requiring treatment adjustment.

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