Is plasma neutrophil gelatinase-associated lipocalin a predictive biomarker for acute kidney injury in sepsis patients? A systematic review and meta-analysis

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• 作者：Sollip Kim ; MD^a ; ¹ ; Hyun-Jung Kim ; MD^b ; ¹ ; Hyeong-Sik Ahn ; MD^b ; Ji Yang Song ; RN^b ; Tae-Hyun Um ; MD^a ; Chong-Rae Cho ; MD^a ; Hoon Jung ; MD^c ; Hyeon-Kyoung Koo ; MD^c ; Joo Hyun Park ; MD^c ; Sung-Soon Lee ; MD^c ; Hye Kyeong Park ; MD^c ; ^{stella_park@paik.ac.kr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Neutrophil gelatinase-associated lipocalin (NGAL) ; Plasma NGAL ; Urine NGAL ; Meta-analysis ; Acute kidney injury ; Sepsis
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：33
• 期：Complete
• 页码：213-223
• 全文大小：1134 K

文摘

Neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for early diagnosis of acute kidney injury (AKI). However, the diagnostic value of NGAL for predicting AKI in sepsis patients is unclear.

Methods

MEDLINE, EMBASE, and Cochrane Library databases were searched to identify research publications.

Results

Twelve studies from 9 countries including a total of 1582 patients, of whom 315 (19.9%) developed AKI, were included in the study; plasma NGAL levels were significantly higher in adult sepsis patients with AKI than in those without AKI (mean difference, 274.65; 95% confidence interval [CI], 106.16-443.15; I² = 94%). Urine NGAL levels were not significantly different. The diagnostic odds ratio of plasma NGAL for predicting 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, 0.474 (95% CI, 0.367-0.582) for specificity, 0.216 (95% CI, 0.177-0.261) for positive predictive value and 0.965 (95% CI, 0.945-0.977) for negative predictive value.

Conclusion

Plasma NGAL has a high sensitivity and a high negative predictive value for detection of AKI in adult sepsis patients. However, its low specificity and low positive predictive value could limit its clinical utility. The usefulness of urine NGAL was not revealed in this study.