What question did this study set out to answer?

To assess whether measuring blood neutrophil gelatinase-associated lipocalin (NGAL) improves early acute kidney injury diagnosis and in-hospital mortality prediction alongside emergency clinical evaluation.

February 12, 2013Critical CareOpen Access

Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department

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Authors

SSSalvatore Di SommaHeart Failure & Transplant LML. MagriniArcetri Astrophysical Observatory BBBenedetta De BerardinisSanta Lucía University General Hospital

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Implication

Prospective cohort study demonstrates that blood NGAL improves emergency acute kidney injury diagnosis and mortality risk stratification, highlighting its utility as an early biomarker.

Key Points

To assess whether measuring blood neutrophil gelatinase-associated lipocalin (NGAL) improves early acute kidney injury diagnosis and in-hospital mortality prediction alongside emergency clinical evaluation.
Conducted a multicenter prospective cohort study in Italy enrolling 665 patients admitted to the hospital from the emergency department.
Measured blood NGAL and serum creatinine at emergency presentation (T0) and at 6, 12, 24, and 72 hours, comparing initial emergency clinician judgment with expert nephrologist diagnoses based on RIFLE criteria.
Emergency physicians initially suspected acute kidney injury in 33% of patients (218/665), but expert adjudication confirmed it in only 7% (49/665), reflecting initial overprediction in 27% and missed diagnoses in 20%.
Adding T0 blood NGAL to emergency physician judgment increased diagnostic discrimination from an AUC of 0.80 (NGAL alone) to 0.90, significantly outperforming T0 eGFR models (AUC 0.78; P=0.022 for MDRD, P=0.020 for Cockcroft-Gault) with a net reclassification improvement of 32.4 percentage points over serum creatinine.
Serial NGAL measurements at 0 and 6 hours yielded a 98% negative predictive value for ruling out acute kidney injury, while a baseline NGAL cutoff of 400 ng/ml provided the strongest prediction of in-hospital mortality.

Cite This Study

Somma et al. (2013) studied this question.

synapsesocial.com/papers/6a97fb938818801a6fe1860f https://doi.org/10.1186/cc12510

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Implication

Prospective cohort study demonstrates that blood NGAL improves emergency acute kidney injury diagnosis and mortality risk stratification, highlighting its utility as an early biomarker.

Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department

Discussion

Member takes

Implication

Key Points

Cite This Study

Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department

Discussion

Member takes

Implication

Key Points

Cite This Study

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