Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian Hospital
Introduction: Serum creatinine (SCr) is used to diagnose acute kidney injury (AKI) but has limited utility to distinguish volume depletion from tubular injury. Urine neutrophil gelatinase-associated lipocalin (uNGAL) distinguishes these causes of elevated SCr. Methods: We tested a novel point-of-car...
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Elsevier
2025-06-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S246802492500169X |
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| author | Tejashree S. Gopal Katherine Xu Yechiel Muller Jai Radhakrishnan Vivekanandan Pillai Jonathan Barasch Sreejith Parameswaran Catherine S. Forster |
| author_facet | Tejashree S. Gopal Katherine Xu Yechiel Muller Jai Radhakrishnan Vivekanandan Pillai Jonathan Barasch Sreejith Parameswaran Catherine S. Forster |
| author_sort | Tejashree S. Gopal |
| collection | DOAJ |
| description | Introduction: Serum creatinine (SCr) is used to diagnose acute kidney injury (AKI) but has limited utility to distinguish volume depletion from tubular injury. Urine neutrophil gelatinase-associated lipocalin (uNGAL) distinguishes these causes of elevated SCr. Methods: We tested a novel point-of-care (POC) dipstick to measure uNGAL at presentation at the emergency medical services department (EMSD) in a tertiary care hospital in Puducherry, India. The primary outcome was a sustained elevation of SCr; the secondary outcome was in-hospital mortality. The study enrolled 396 patients with a mean age of 49.7 years (SD: 16); 36% were female. Sufficient measurements for SCr kinetics were obtained from 229 patients. Owing to inconsistent serial measurements of SCr for some patients, subanalyses were conducted for “strict” and “inclusive” SCr defined subsets, which yielded similar results. Results: Elevated uNGAL (median [interquartile range]: 500 ± 350 ng/ml) in the EMSD indicated sustained increases of SCr (> 48 hours); whereas much lower levels of uNGAL indicated either transient changes (< 48 hours; 150 ± 250 ng/ml) or no elevation of SCr (50 ± 97.5 ng/ml) (P < 0.01). Analysis of the entire cohort (N = 229) or the “strict” subset with complete SCr measurements (n = 129) (P < 0.01) yielded similar data. uNGAL was highly specific and moderately sensitive (specificity: 0.90 [0.83–0.95]; sensitivity: 0.82 [0.67–0.96]) to indicate sustained elevation of SCr (area under the curve–receiver operating characteristic curve: 0.86; confidence interval: [0.76–0.96] and odds ratio [OR]: 16.19; confidence interval: [5.63–59.02] for NGAL levels > 125 ng/ml). Elevated uNGAL was also associated with mortality (OR: 3.91 [confidence interval: 2.17–7.33]). uNGAL, infection, and proteinuria demonstrated limited correlations (R2 = 0.26; P < 10−36). Conclusion: uNGAL dipstick can diagnose kidney damage associated with sustained elevation of SCr and death at patient encounter in the EMSD. |
| format | Article |
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| institution | OA Journals |
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| language | English |
| publishDate | 2025-06-01 |
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| spelling | doaj-art-a12787236fd04bcbbaf85e20dd56f40a2025-08-20T02:33:42ZengElsevierKidney International Reports2468-02492025-06-011061971197910.1016/j.ekir.2025.03.026Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian HospitalTejashree S. Gopal0Katherine Xu1Yechiel Muller2Jai Radhakrishnan3Vivekanandan Pillai4Jonathan Barasch5Sreejith Parameswaran6Catherine S. Forster7Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USADepartment of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USADepartment of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USADepartment of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USANephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IndiaDepartment of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Correspondence: Jonathan Barasch, Department of Medicine (Nephrology), Columbia University, 1150 St Nicholas Avenue New York, New York 10032, USA.Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India; Sreejith Parameswaran, Nephrology, XQ2X+4VC, Jawaharlal Institute of Postgraduate Medical Education and Research, Campus Rd, Puducherry, 605006, India.Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Catherine Forster, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, Pennsylvania 15224-1334, USA.Introduction: Serum creatinine (SCr) is used to diagnose acute kidney injury (AKI) but has limited utility to distinguish volume depletion from tubular injury. Urine neutrophil gelatinase-associated lipocalin (uNGAL) distinguishes these causes of elevated SCr. Methods: We tested a novel point-of-care (POC) dipstick to measure uNGAL at presentation at the emergency medical services department (EMSD) in a tertiary care hospital in Puducherry, India. The primary outcome was a sustained elevation of SCr; the secondary outcome was in-hospital mortality. The study enrolled 396 patients with a mean age of 49.7 years (SD: 16); 36% were female. Sufficient measurements for SCr kinetics were obtained from 229 patients. Owing to inconsistent serial measurements of SCr for some patients, subanalyses were conducted for “strict” and “inclusive” SCr defined subsets, which yielded similar results. Results: Elevated uNGAL (median [interquartile range]: 500 ± 350 ng/ml) in the EMSD indicated sustained increases of SCr (> 48 hours); whereas much lower levels of uNGAL indicated either transient changes (< 48 hours; 150 ± 250 ng/ml) or no elevation of SCr (50 ± 97.5 ng/ml) (P < 0.01). Analysis of the entire cohort (N = 229) or the “strict” subset with complete SCr measurements (n = 129) (P < 0.01) yielded similar data. uNGAL was highly specific and moderately sensitive (specificity: 0.90 [0.83–0.95]; sensitivity: 0.82 [0.67–0.96]) to indicate sustained elevation of SCr (area under the curve–receiver operating characteristic curve: 0.86; confidence interval: [0.76–0.96] and odds ratio [OR]: 16.19; confidence interval: [5.63–59.02] for NGAL levels > 125 ng/ml). Elevated uNGAL was also associated with mortality (OR: 3.91 [confidence interval: 2.17–7.33]). uNGAL, infection, and proteinuria demonstrated limited correlations (R2 = 0.26; P < 10−36). Conclusion: uNGAL dipstick can diagnose kidney damage associated with sustained elevation of SCr and death at patient encounter in the EMSD.http://www.sciencedirect.com/science/article/pii/S246802492500169XAKIdipstickNGAL |
| spellingShingle | Tejashree S. Gopal Katherine Xu Yechiel Muller Jai Radhakrishnan Vivekanandan Pillai Jonathan Barasch Sreejith Parameswaran Catherine S. Forster Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian Hospital Kidney International Reports AKI dipstick NGAL |
| title | Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian Hospital |
| title_full | Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian Hospital |
| title_fullStr | Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian Hospital |
| title_full_unstemmed | Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian Hospital |
| title_short | Prospective Study of a Point-of-Care Diagnostic Test for Acute Kidney Injury in a South Asian Hospital |
| title_sort | prospective study of a point of care diagnostic test for acute kidney injury in a south asian hospital |
| topic | AKI dipstick NGAL |
| url | http://www.sciencedirect.com/science/article/pii/S246802492500169X |
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