Key result
Indexed NGAL linked to ~22% higher odds of post-TAVR acute kidney injury in CKD.
Observational (n=134)
Open-label
No
Evaluates indexed NGAL for predicting CI-AKI in CKD patients, suggesting improved predictive accuracy.
Background: The risk for contrast-induced acute kidney injury (CI-AKI) following cardiac procedures involving contrast administration is particularly high among chronic kidney disease (CKD) patients. Neutrophil gelatinase-associated lipocain (NGAL) has been widely studied as an early marker for renal injury. However, CKD could impact NGAL levels and alter their predictive performance. This study aimed to evaluate a novel baseline “indexed NGAL” (I-NGAL), calculated by adjusting NGAL to the estimated glomerular filtration rate (eGFR), for the prediction of CI-AKI in CKD patients undergoing elective transcatheter aortic valve replacement (TAVR). Methods: A total of 134 CKD patients undergoing elective TAVR were included. Serum NGAL levels were drawn at hospital admission. Patients were followed for the occurrence of CI-AKI. Receiver-operator characteristic (ROC) methods were used to identify optimal sensitivity and specificity for I-NGAL. Univariate and multivariate binary logistic regression models were used to assess I-NGAL predictive performance. Results: Overall 35/134 patients (26%) developed CI-AKI following TAVR both NGAL and I-NGAL were significantly higher among patients having CI-AKI. I-NGAL results had a higher predictive ability than unindexed NGAL results (AUC of 0.83 vs. 0.78, p<0.001). The optimal I-NGAL cutoff for prediction of CI-AKI was 4, with sensitivity of 71%, specificity of 77%, and a negative predictive value (NPV) of 88%. In a multivariate logistic regression model, I-NGAL was independently associated with CI-AKI (OR 1.22, 95% CI: 1.05-1.41; p = 0.007). I-NGAL level>4 was also independently associated with CI-AKI (OR 8.13, 95% CI 3-21.8, p<0.001). Conclusion: Among CKD patients undergoing elective TAVR, adjusting baseline NGAL values according to eGFR yields an indexed NGAL that serves as an improved tool for predicting and ruling out CI-AKI, regardless of baseline renal function.
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Khoury et al. (2026) conducted an observational in Chronic kidney disease undergoing elective transcatheter aortic valve replacement (TAVR) (n=134). Indexed neutrophil gelatinase-associated lipocalin (I-NGAL; NGAL/baseline eGFR) vs. Unadjusted baseline NGAL / I-NGAL <= 4 was evaluated on Contrast-induced acute kidney injury (CI-AKI; KDIGO criteria: increase in sCr >=0.3 mg/dL or >=1.5 times baseline) (OR 1.22, 95% CI 1.05-1.41, p=0.007). Indexed NGAL independently predicted contrast-induced AKI in CKD patients after TAVR (OR 1.22, 95% CI 1.05-1.41, p=0.007; OR 8.13 for >4) and outperformed unadjusted NGAL (AUC 0.83 vs 0.78, p<0.001).
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