Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/23867
Title: Neutrophil Gelatinase-Associated Lipocalin Measured on Clinical Laboratory Platforms for the Prediction of Acute Kidney Injury and the Associated Need for Dialysis Therapy: A Systematic Review and Meta-analysis.
Austin Authors: Albert, Christian;Zapf, Antonia;Haase, Michael;Röver, Christian;Pickering, John W;Albert, Annemarie;Bellomo, Rinaldo ;Breidthardt, Tobias;Camou, Fabrice;Chen, Zhongquing;Chocron, Sidney;Cruz, Dinna;de Geus, Hilde Rh;Devarajan, Prasad;Di Somma, Salvatore;Doi, Kent;Endre, Zoltan H;Garcia-Alvarez, Mercedes;Hjortrup, Peter B;Hur, Mina;Karaolanis, Georgios;Kavalci, Cemil;Kim, Hanah;Lentini, Paolo;Liebetrau, Christoph;Lipcsey, Miklós;Mårtensson, Johan;Müller, Christian;Nanas, Serafim;Nickolas, Thomas L;Pipili, Chrysoula;Ronco, Claudio;Rosa-Diez, Guillermo J;Ralib, Azrina;Soto, Karina;Braun-Dullaeus, Rüdiger C;Heinz, Judith;Haase-Fielitz, Anja
Affiliation: University Clinic for Cardiology and Angiology, Medical Faculty, Otto-von-Guericke University.
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
Division of Nephrology-Hypertension, University of California, San Diego, CA, USA
Division of Nephrology and Hypertension, Cincinnati Children's Hospital, University of Cincinnati, USA
Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Faculty of Medicine, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany; Diaverum Renal Services Germany, MVZ Am Neuen Garten, 14469, Potsdam, Germanydst
Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany
Department of Medicine, University of Otago Christchurch, and Emergency Department, Christchurch Hospital, Christchurch, New Zealand
Department for Nephrology and Endocrinology, Klinikum Ernst von Bergmann, Potsdam, Germany; Diaverum Renal Services Germany, MVZ Am Neuen Garten, 14469, Potsdam, Germany
Departments of Internal Medicine, Nephrology and Cardiology, University Hospital Basel, Switzerland
Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, France
Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong 510515, China
Department of Thoracic and Cardio-Vascular Surgery, EA3920, University Hospital Jean Minjoz, Blvd Fleming, 25000 Besançon
Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sapienza' University of Rome S. Andrea Hospital, 'via di Grottarossa 1035-1039, Rome 00189, Italy
Department of Emergency and Critical Care Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, High Street, Randwick, Sydney
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark
Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
Vascular Unit, First Department of Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Emergency Department, Baskent University Faculty of Medicine, Ankara, Turkey
Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
Department of Nephrology and Dialysis, San Bassiano Hospital, Via Dei Lotti,40 36061 Bassano del Grappa Italy
Department of Cardiology, Kerckhoff Clinic, Benekestraße 2-8, 61231 Bad Nauheim, Germany
CIRRUS, Hedenstierna laboratory, Anaesthesiology and Intensive care, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset 751 85, Uppsala, Sweden
Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet Stockholm, Sweden
Departments of Internal Medicine, Nephrology and Cardiology, University Hospital Basel, Switzerland
First Critical Care Department, 'Evangelismos' General Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, 10675, Athens, Greece
Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032
First Critical Care Department, 'Evangelismos' General Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, 10675, Athens, Greece
University of Padova; Director Dep. Nephrology Dialysis & Transplantation, AULSS8, Regione Veneto, Vicenza, Italy; International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
Department of Nephrology, Dialysis and Transplantation, Hospital Italiano de Buenos Aires, Perón 4190, 1181 Buenos Aires, Argentina
Department of Anaesthesiology and Intensive Care, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
Department of Nephrology, Hospital Fernando Fonseca, Lisbon, Portugal CEAUL, Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
University Clinic for Cardiology and Angiology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany
Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Faculty of Health Sciences, University of Potsdam, Germany
Intensive Care
Issue Date: 15-Jul-2020
metadata.dc.date: 2020-07-15
Publication information: American Journal of Kidney Diseases 2020; online first: 15 July
Abstract: The usefulness of measures of neutrophil gelatinase-associated lipocalin in urine or plasma (u/pNGAL) obtained on clinical laboratory platforms for predicting acute kidney injury (AKI) and severe AKI requiring kidney dialysis (AKI-D) has not been fully evaluated. We sought to quantitatively summarize published data to evaluate the value of urinary and plasma NGAL for prediction. Literature-based meta-analysis and individual-study-data meta-analysis of diagnostic studies following PRISMA-IPD guidelines. Studies of adults investigating AKI, severe AKI, and AKI-D in the setting of cardiac surgery, intensive care, or emergency department care using either urine or plasma NGAL measured on clinical laboratory platforms. PubMed, Web of Science, Cochrane Library, Scopus and congress abstracts ever published through February 2020 reporting diagnostic test studies of NGAL measured on clinical laboratory platforms to predict AKI. Individual-study-data meta-analysis was accomplished by providing authors data specifications tailored to their studies and requesting standardized patient-level data analysis. Individual-study-data meta-analysis utilized a bivariate time-to-event model for interval-censored data from which discriminative ability (area under the receiver operating characteristic curve (AUC)) was characterized. NGAL cutoff concentrations at 95% sensitivity, 95% specificity, as well as optimal sensitivity and specificity were also estimated. Models incorporated as confounders clinical setting and use versus non-use of urine output as a criterion for AKI. A literature-based meta-analysis was also performed for all published studies including those studies for which the authors were unable to provide individual study data analyses. We included 52 observational studies involving 13,040 patients. We analyzed 30 datasets for the individual-study-data meta-analysis with 837 AKI events, 304 severe AKI events, and 103 severe AKI-D events for analyses of urine NGAL and 705 AKI events, 271 severe AKI events, and 178 AKI-D events for analyses of plasma NGAL. Discriminative performance was similar in individual-study-data meta-analysis and literature-based meta-analysis. Individual-study-data meta-analysis AUCs for uNGAL were 0.75 (95% CI 0.73-0.76) and 0.80 (0.79-0.81) for severe AKI and AKI-D, respectively; for pNGAL, the corresponding values were 0.80 (0.79-0.81) and 0.86 (0.84-0.86). Cut-off-concentrations at 95% specificity for uNGAL were >580 ng/mL with 27% sensitivity for severe AKI and >589 ng/mL with 24% sensitivity for AKI-D. Corresponding cut-offs for pNGAL were >364 ng/mL with 44% sensitivity and >546 ng/mL with 26% sensitivity, respectively. Practice variability on initiation of acute dialysis. Imperfect harmonization of data across studies. Urinary and plasma NGAL concentrations may identify patients at high risk for AKI in clinical research and practice. The reported cut-off concentrations in this study require prospective evaluation.
URI: http://ahro.austin.org.au/austinjspui/handle/1/23867
DOI: 10.1053/j.ajkd.2020.05.015
PubMed URL: 32679151
Type: Journal Article
Subjects: NGAL
acute kidney injury
cut-off value
meta-analysis
neutrophil gelatinase-associated lipocalin
plasma NGAL
renal replacement therapy
renal risk assessment
urine NGAL
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