Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children
Introduction: Acute kidney injury (AKI) defined by changes in serum creatinine (SCr), or oliguria is associated with increased morbidity and mortality in children who are critically ill. We derived and validated a clinical cutoff value for urine neutrophil gelatinase-associated lipocalin (NGAL), in...
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Elsevier
2024-08-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924017182 |
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| author | Stuart L. Goldstein Ayse Akcan-Arikan Natasha Afonso David J. Askenazi Abby M. Basalely Rajit K. Basu Hostensia Beng Julie C. Fitzgerald Katja Gist Sarah Kizilbash David Kwiatkowski Christopher W. Mastropietro Shina Menon Megan SooHoo Avram Z. Traum Christopher A. Bird |
| author_facet | Stuart L. Goldstein Ayse Akcan-Arikan Natasha Afonso David J. Askenazi Abby M. Basalely Rajit K. Basu Hostensia Beng Julie C. Fitzgerald Katja Gist Sarah Kizilbash David Kwiatkowski Christopher W. Mastropietro Shina Menon Megan SooHoo Avram Z. Traum Christopher A. Bird |
| author_sort | Stuart L. Goldstein |
| collection | DOAJ |
| description | Introduction: Acute kidney injury (AKI) defined by changes in serum creatinine (SCr), or oliguria is associated with increased morbidity and mortality in children who are critically ill. We derived and validated a clinical cutoff value for urine neutrophil gelatinase-associated lipocalin (NGAL), in a prospective multicenter study of children who were critically ill. We report the clinical performance of urine NGAL (uNGAL) to aid in pediatric AKI risk assessment. Methods: Eligible subjects were aged ≥ 90 days to < 22 years, admitted to an intensive care unit (ICU), and had 1 or more of the following: mechanical ventilation, vasoactive medication administration, solid organ or bone marrow transplantation, or hypotension within 24-hours of admission. uNGAL was assessed within 24-hours of admission. The primary outcome was SCr-based stage 2/3 AKI presence at 48- to 72-hours. Results: Twenty-five (12.3%) derivation study patients had stage 2/3 AKI at 48- to 72-hours. uNGAL concentration of 125 ng/ml was the optimal cutoff. Forty-seven (9.1%) validation study patients had stage 2/3 AKI at 48- to 72-hours. The area under the curve of a receiver operator characteristics curve (AUC-ROC) for uNGAL performance was 0.83 (95% confidence interval [CI]: 0.77–0.90). Performance characteristics were sensitivity 72.3% (95% CI: 57.4%–84.4%), specificity 86.3% (95% CI: 82.8%–89.3%), positive predictive value 34.7% (95% CI: 28.5%–41.5%), and negative predictive value 96.9% (95% CI: 95.1%–98.0%). Conclusion: These prospective, pediatric, multicenter studies demonstrate that uNGAL in the first 24-hours performs very well to predict Kidney Disease Improving Global Outcomes (KDIGO) stage 2/3 AKI at 48- to 72-hours into an ICU course. We suggest that a uNGAL cut point of 125 ng/ml can aid in the risk assessment for stage 2/3 AKI persistence or development. |
| format | Article |
| id | doaj-art-1b04cbe3db0c473c9693f96378f3c032 |
| institution | DOAJ |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Elsevier |
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| series | Kidney International Reports |
| spelling | doaj-art-1b04cbe3db0c473c9693f96378f3c0322025-08-20T03:21:18ZengElsevierKidney International Reports2468-02492024-08-01982443245210.1016/j.ekir.2024.05.010Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill ChildrenStuart L. Goldstein0Ayse Akcan-Arikan1Natasha Afonso2David J. Askenazi3Abby M. Basalely4Rajit K. Basu5Hostensia Beng6Julie C. Fitzgerald7Katja Gist8Sarah Kizilbash9David Kwiatkowski10Christopher W. Mastropietro11Shina Menon12Megan SooHoo13Avram Z. Traum14Christopher A. Bird15Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Correspondence: Stuart L. Goldstein, Director, Center for Acute Care Nephrology, Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 7022, Cincinnati, Ohio 45229, USA.Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USABaylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USAChildren’s of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USACohen Children’s Medical Center at Northwell Health, New York, USALurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USAEast Carolina University Brody School of Medicine, Greenville, North Carolina, USAChildren’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USACincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USAUniversity of Minnesota Children’s Hospital Minneapolis, Minnesota, USALucille Packard Children’s Hospital Stanford University, Palo Alto, California, USARiley Hospital for Children at Indiana University Health University of Indiana School of Medicine, Indianapolis, Indiana, USASeattle Children’s Hospital, Seattle, Washington, USAChildren’s Hospital of Colorado, Aurora, Colorado, USABoston Children’s Hospital, Boston, Massachusetts, USABioPorto Diagnostics, Copenhagen, Denmark, EuropeIntroduction: Acute kidney injury (AKI) defined by changes in serum creatinine (SCr), or oliguria is associated with increased morbidity and mortality in children who are critically ill. We derived and validated a clinical cutoff value for urine neutrophil gelatinase-associated lipocalin (NGAL), in a prospective multicenter study of children who were critically ill. We report the clinical performance of urine NGAL (uNGAL) to aid in pediatric AKI risk assessment. Methods: Eligible subjects were aged ≥ 90 days to < 22 years, admitted to an intensive care unit (ICU), and had 1 or more of the following: mechanical ventilation, vasoactive medication administration, solid organ or bone marrow transplantation, or hypotension within 24-hours of admission. uNGAL was assessed within 24-hours of admission. The primary outcome was SCr-based stage 2/3 AKI presence at 48- to 72-hours. Results: Twenty-five (12.3%) derivation study patients had stage 2/3 AKI at 48- to 72-hours. uNGAL concentration of 125 ng/ml was the optimal cutoff. Forty-seven (9.1%) validation study patients had stage 2/3 AKI at 48- to 72-hours. The area under the curve of a receiver operator characteristics curve (AUC-ROC) for uNGAL performance was 0.83 (95% confidence interval [CI]: 0.77–0.90). Performance characteristics were sensitivity 72.3% (95% CI: 57.4%–84.4%), specificity 86.3% (95% CI: 82.8%–89.3%), positive predictive value 34.7% (95% CI: 28.5%–41.5%), and negative predictive value 96.9% (95% CI: 95.1%–98.0%). Conclusion: These prospective, pediatric, multicenter studies demonstrate that uNGAL in the first 24-hours performs very well to predict Kidney Disease Improving Global Outcomes (KDIGO) stage 2/3 AKI at 48- to 72-hours into an ICU course. We suggest that a uNGAL cut point of 125 ng/ml can aid in the risk assessment for stage 2/3 AKI persistence or development.http://www.sciencedirect.com/science/article/pii/S2468024924017182acute kidney injurychildrenneutrophil gelatinase-associated lipocalinNGAL |
| spellingShingle | Stuart L. Goldstein Ayse Akcan-Arikan Natasha Afonso David J. Askenazi Abby M. Basalely Rajit K. Basu Hostensia Beng Julie C. Fitzgerald Katja Gist Sarah Kizilbash David Kwiatkowski Christopher W. Mastropietro Shina Menon Megan SooHoo Avram Z. Traum Christopher A. Bird Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children Kidney International Reports acute kidney injury children neutrophil gelatinase-associated lipocalin NGAL |
| title | Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children |
| title_full | Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children |
| title_fullStr | Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children |
| title_full_unstemmed | Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children |
| title_short | Derivation and Validation of an Optimal Neutrophil Gelatinase-Associated Lipocalin Cutoff to Predict Stage 2/3 Acute Kidney Injury (AKI) in Critically Ill Children |
| title_sort | derivation and validation of an optimal neutrophil gelatinase associated lipocalin cutoff to predict stage 2 3 acute kidney injury aki in critically ill children |
| topic | acute kidney injury children neutrophil gelatinase-associated lipocalin NGAL |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924017182 |
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