Does plasma NGAL help for prediction of acute kidney injury in sepsis patients?: A systematic review and meta-analysis

Abstract

Purpose: Neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for early diagnosis of acute kidney injury (AKI), and can also be elevated in patients with sepsis. However, the diagnostic value of NGAL for predicting AKI in sepsis patients is uncertain. We conducted a systematic review and meta-analysis to evaluate the diagnostic value of plasma and urine NGAL in predicting AKI in sepsis patients. Methods: The MEDLINE, EMBASE, and Cochrane Library databases were searched. Results: Thirteen studies from nine countries with a total of 1,592 patients, of whom 329 (20.7%) developed AKI, were included; plasma NGAL levels were significantly higher in adult sepsis patients with AKI than in those without AKI (mean difference 274.7 (95% CI 106.16-443.15), I2 = 94%). Urine NGAL levels of adult sepsis patients and plasma/urine NGAL levels of pediatric sepsis patients with and without AKI were not significantly different. The diagnostic odds ratio of plasma NGAL to predict AKI in sepsis patients was 6.64 (95% CI, 3.80-11.58). The diagnostic accuracy of plasma NGAL was 0.881 (95% CI, 0.819-0.923) for sensitivity and 0.474 (95% CI, 0.367-0.582) for specificity. Conclusion: Plasma NGAL is a useful early marker for predicting AKI in adult sepsis patients. Reference: Bagshaw SM, Bennett M, Haase M, et al. Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med. 2010;36:452-61. Acute renal failure in critically ill patients: a multinational,multicenter study. JAMA 2005;294:813-18.