Biomarkers containing neutrophil gelatinase-associated lipocalin accurately predict hospital acquired AKI

TAIWAN: According to a study that was published in the journal Critical Care, biomarkers comprising neutrophil gelatinase-associated lipocalin (NGAL) had the best predictive accuracy for the incidence of AKI, irrespective of whether the values were adjusted by urinary creatinine. This was especially true in patients who were receiving medical treatment.

Acute kidney injury (AKI) is linked to a higher risk of end-stage renal disease, chronic kidney disease, and long-term detrimental cardiovascular effects. The optimal approach in clinical practice is to identify AKI as early as feasible, correct its cause, and even ameliorate the sequelae due to the absence of effective treatments for decreased kidney function.

Acute kidney injury (AKI) has been predicted by a number of distinct biomarkers; however, their accuracy differs across studies.

The purpose of this research was to assess the quality of the evidence using a pairwise meta-analysis and evaluate the stated predictive accuracy of AKI biomarkers in various clinical scenarios.

For papers published up to August 15, 2022, the researchers examined PubMed, Medline, Embase, and the Cochrane Library. They chose all research articles involving adults (> 18 years) that discussed the prognostic value of damage biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), inflammatory biomarker (interleukin-18 [IL-18]), and stress biomarkers [tissue inhibitor of metalloproteinases-2 [TIMP-2] insulin. 1,803 analyzed abstracts yielded 242 published relevant research, of which 110 studies with 38,725 patients were included in this meta-analysis.

To determine odds ratios (ORs) and 95% confidence intervals (CIs), the authors conducted paired meta-analyses. The pooled test performance was summarized using hierarchical summary receiver operating characteristic curves (HSROCs), and the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations standards.

Conclusive points:

• The best diagnostic adequacy for the risk of AKI was demonstrated by urinary NGAL/creatinine (diagnostic odds ratio [DOR] 16.2, 95% CI 10.1-25.9), urinary NGAL (DOR 13.8, 95% CI 10.2-18.8), and serum NGAL (DOR 12.6, 95% CI 9.3-17.3).
• When compared to urinary IL-18 in non-critically sick patients, urinary NGAL, urinary NGAL/creatinine, and serum NGAL all demonstrated higher diagnostic accuracies for AKI.
• In severely ill patients, the diagnostic efficacy of all the biomarkers was comparable.
• Urinary NGAL performed better in terms of prediction in the context of medical and non-sepsis patients than urinary IL-18, urinary L-FABP, and urinary TIMP-2 IGFBP-7: 0.3.
• Urine NGAL/creatinine and urinary KIM-1 exhibited the highest diagnostic specificity in surgical patients.
• Urine NGAL/creatinine, urinary NGAL, and serum NGAL all had HSROC values of 91.4%, 85.2%, and 84.7%, respectively.

The authors came to the conclusion that urinary NGAL's predictive performance in surgical patients was constrained, and that urinary NGAL/creatinine appeared to be the most reliable biomarker in these patients.

In severely ill patients, the prediction performance of all the biomarkers was comparable.

Future pragmatic clinical trials are necessary to assess how well AKI biomarkers predict outcomes in the real world, they added.

REFERENCE

Pan, HC., Yang, SY., Chiou, T.TY. et al. Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis. Crit Care 26, 349 (2022). https://doi.org/10.1186/s13054-022-04223-6