Albert, Annemarie and Blume, Louisa and Di Somma, Salvatore and Hur, Mina and Bellomo, Rinaldo and Devarajan, Prasad and Breidthardt, Tobias and Camou, Fabrice and Chocron, Sidney and Cruz, Dinna and de Geus, Hilde and Doi,, Kent and Endre, Zoltan H. and Garcia-Alvarez,, Mercedes and Haase, Michael and Haase-Fielitz, Anja and Hjortrup, Peter Buhl and Karaolanis, Georgios and Kavalci, Cemil and Kim, Hanah and Lange, Sebastian and Lauten, Phillipp and Lentini, Paola and Liebetrau, Christoph and Lipcsey,, Mikios and Mårtensson, Johan and Müller, Christian and Nanas, Serafim and Nickolas, Thomas and Pickering, John W. and Pipili, Chrysoula and Ronco, Claudio and Rosa-Diez, Guillermo and Md Ralib, Azrina and Soto, Karina and Stieger, Philipp and Zapf, Antonia and Braun-Dullaeus, Rudiger and Albert, Christian (2026) Difference of admission neutrophil gelatinase-associated lipocalin concentration between patients developing and not developing acute kidney injury or need for acute dialysis: An ancillary individual-study data meta-analysis (INDICATE–AKI). Kidney Medicine, 8 (5). pp. 1-15. ISSN 2590-0595
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Abstract
Rationale & Objective Patients admitted to the emergency department (ED), the intensive care unit (ICU) and after cardiac surgery (CS) are at increased risk of developing adverse kidney events. Neutrophil gelatinase-associated lipocalin (NGAL) may facilitate renal risk prediction. However, the difference in NGAL-concentrations at admission in patients developing and not developing adverse events is unclear. Study Design An ancillary meta-analysis to a previous systematic review and meta-analysis using reanalyzed individual study-data from prospective clinical studies to compare NGAL concentrations measured using clinical laboratory platforms at patient admission. The study followed the PRISMA-IPD guideline. Setting & Study Populations Studies of adults investigating acute kidney injury of all stages (AKI), severe AKI (stage injury or failure), and acute initiation of renal replacement therapy (RRT) in the setting of CS, ED or ICU using either urinary or plasma NGAL measured on clinical laboratory platforms. Selection Criteria for Studies Data inclusion was limited to the individual study-level-data from the predecessor study. Data Extraction This study used individual study-level-data acquired by protocol of a previous study which was accomplished by individual authors reassessment of their study-data. Analytical Approach Classification of AKI was harmonized among studies. Prespecified data comparison was performed for urine and plasma specimens for the outcome measures AKI, severe AKI and acute RRT-initiation. Random effects meta-analyses were performed using the inverse variance method and DerSimonian&Laird heterogeneity estimator. Results In total, 30 datasets from 26 studies were included. The estimated mean difference of urine NGAL were 125ng/mL (57.33–193.54, 95% CI) for AKI, 317ng/mL (134.95–499.82) for severe AKI, and 331ng/mL (71.36–592.06) for RRT. For plasma NGAL the estimated mean difference were 86.04ng/mL (51.74–120.34) for AKI, 150.52ng/mL (80.27–220.76) for severe AKI and 129.83ng/mL (79.03–180.63) for RRT. There were subgroup differences for clinical setting but not for the use of urine output criterion. Multiple studies showed elevated NGAL concentrations in patients without SCr-based AKI likely identifying patients with suspected AKI stage 1S (subclinical AKI). Limitations Imperfect harmonization of data across studies due to their original protocols Conclusions NGAL differences may facilitate identification of patients at risk of AKI or with suspected AKI stage 1S at admission. Heterogeneity and variability across studies, specimen types and settings emphasize the importance of interpreting NGAL values within the specific clinical context and patient population.
| Item Type: | Article (Journal) |
|---|---|
| Uncontrolled Keywords: | acute kidney injury, neutrophil gelatinase-associated lipocalin, subclinical AKI, meta-analysis, renal replacement therapy, renal risk assessment, clinical decision making |
| 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 |
| Depositing User: | Prof Azrina Md Ralib |
| Date Deposited: | 30 Apr 2026 12:44 |
| Last Modified: | 30 Apr 2026 12:44 |
| Queue Number: | 2026-04-Q2928 |
| URI: | http://irep.iium.edu.my/id/eprint/128167 |
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Difference of Admission Neutrophil Gelatinase-Associated Lipocalin Concentration Between Patients Developing and Not Developing Acute Kidney Injury or Need for Acute Dialysis: An Ancillary Individual-Study Data Meta-Analysis (INDICATE–AKI). (deposited UNSPECIFIED)
- Difference of admission neutrophil gelatinase-associated lipocalin concentration between patients developing and not developing acute kidney injury or need for acute dialysis: An ancillary individual-study data meta-analysis (INDICATE–AKI). (deposited 30 Apr 2026 12:44) [Currently Displayed]
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