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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

Albert, Christian and Zapf, Antonia and Haase, Michael and Rover, Christian and W. Pickering, John W. and Albert, Annemarie and Bellomo, Rinaldo and Breidthardt, Tobias and Camou, Fabrice and Chen, Zhongquing and Chocron, Sidney and Cruz, Dinna and R.H. de Geus, Hilde and Devarajan, Prasad and Di Somma, Salvatore and Doi,, Kent and H. Endre,, Zoltan and Garcia-Alvarez,, Mercedes and B. Hjortrup, Peter and Hur, Mina and Karaolanis, Georgios and Kavalci, Cemil and Kim, Hanah and Lentini, Paola and Liebetrau, Christoph and Lipcsey,, Mikios and Mårtensson, Johan and Müller, Christian and Nanas, Serafim and L. Nickolas,, Thomas and Pipili, Chrysoula and Ronco, Claudio and J. Rosa-Diez,, Guillermo and Md Ralib, Azrina and Soto, Karian and C. Braun-Dullaeus, Rodiger and Heinz, Judith and Haase-Fielitz, Anja (2020) 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. American Journal of Kidney Disease, 76 (6). pp. 826-841. ISSN 0272-6386

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Rationale & Objective: The usefulness of mea- sures of neutrophil gelatinase-associated lipocalin (NGAL) in urine or plasma obtained on clinical laboratory platforms for predicting acute kidney injury (AKI) and AKI requiring 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 kidney risk prediction. Study Design: Literature-based meta-analysis and individual-study-data meta-analysis of diagnostic studies following PRISMA-IPD guidelines. Setting & Study Populations: Studies of adults investigating AKI, severe AKI, and AKI-D in the setting of cardiac surgery, intensive care, or emergency department care using either urinary or plasma NGAL measured on clinical laboratory platforms. Selection Criteria for Studies: 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 plat- forms to predict AKI. Data Extraction: Individual-study-data meta- analysis was accomplished by giving authors data specifications tailored to their studies and requesting standardized patient-level data analysis. Analytical Approach: Individual-study-data meta- analysis used a bivariate time-to-event model for interval-censored data from which discriminative ability (AUC) was characterized. NGAL cutoff concentrations at 95% sensitivity, 95% specificity, and optimal sensitivity and specificity were also estimated. Models incorporated as confounders the clinical setting and use versus nonuse of urine output as a criterion for AKI. A i literature-based meta-analysis was also performed for all published studies including those for which the authors were unable to provide individual-study data analyses. Results: We included 52 observational studies involving 13,040 patients. We analyzed 30 data sets for the individual-study-data meta-analysis. For AKI, severe AKI, and AKI-D, numbers of j events were 837, 304, and 103 for analyses of urinary NGAL, respectively; these values were 705, 271, and 178 for analyses of plasma NGAL. Discriminative performance was similar in both meta-analyses. Individual-study-data meta-analysis AUCs for urinary NGAL were 0.75 (95% CI, 0.73-0.76) and 0.80 (95% CI, 0.79-0.81) for severe AKI and AKI-D, respectively; for plasma NGAL, the corresponding AUCs were 0.80 (95% CI, 0.79- 0.81) and 0.86 (95% CI, 0.84-0.86). Cutoff concentrations at 95% specificity for urinary NGAL were >580 ng/mL with 27% sensitivity for severe AKI and >589 ng/mL with 24% sensitivity for AKI-D. Corresponding cutoffs for plasma NGAL were >364 ng/mL with 44% sensitivity and >546 ng/mL with 26% sensitivity, respectively. Limitations: Practice variability in initiation of dialysis. Imperfect harmonization of data across studies. Conclusions: Urinary and plasma NGAL con- centrations may identify patients at high risk for AKI in clinical research and practice. The cutoff concentrations reported in this study require prospective evaluation.

Item Type: Article (Journal)
Additional Information: 3934/85971
Uncontrolled Keywords: Acute kidney injury
Subjects: R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Kulliyyah of Medicine
Depositing User: Prof Azrina Md Ralib
Date Deposited: 13 Dec 2020 15:14
Last Modified: 13 Dec 2020 15:14
URI: http://irep.iium.edu.my/id/eprint/85971

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