Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults

Retrospective determination and clinical validation of a prospective multicentre study

Kristen M. Tecson, Elisabeth Erhardtsen, Peter M. Eriksen, A. Osama Gaber, Michael Germain, Ladan Golestaneh, Maria De Los Angeles Lavoria, Linda W. Moore, Peter A. McCullough

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives To determine the optimal threshold of blood and urine neutrophil gelatinase-associated lipocalin (NGAL) to predict moderate to severe acute kidney injury (AKI) and persistent moderate to severe AKI lasting at least 48 consecutive hours, as defined by an adjudication panel. Methods A multicentre prospective observational study enrolled intensive care unit (ICU) patients and recorded daily ethylenediaminetetraacetic acid (EDTA) plasma, heparin plasma and urine NGAL. We used natural log-transformed NGAL in a logistic regression model to predict stage 2/3 AKI (defined by Kidney Disease International Global Organization). We performed the same analysis using the NGAL value at the start of persistent stage 2/3 AKI. Results Of 245 subjects, 33 (13.5%) developed stage 2/3 AKI and 25 (10.2%) developed persistent stage 2/3 AKI. Predicting stage 2/3 AKI revealed the optimal NGAL cutoffs in EDTA plasma (142.0 ng/mL), heparin plasma (148.3 ng/mL) and urine (78.0 ng/mL) and yielded the following decision statistics: sensitivity (SN)=78.8%, specificity (SP)=73.0%, positive predictive value (PPV)=31.3%, negative predictive value (NPV)=95.7%, diagnostic accuracy (DA)=73.8% (EDTA plasma); SN=72.7%, SP=73.8%, PPV=30.4%, NPV=94.5%, DA=73.7% (heparin plasma); SN=69.7%, SP=76.8%, PPV=32.9%, NPV=94%, DA=75.8% (urine). The optimal NGAL cutoffs to predict persistent stage 2/3 AKI were similar: 148.3 ng/mL (EDTA plasma), 169.6 ng/mL (heparin plasma) and 79.0 ng/mL (urine) yielding: SN=84.0%, SP=73.5%, PPV=26.6%, NPV=97.6, DA=74.6% (EDTA plasma), SN=84%, SP=76.1%, PPV=26.8%, NPV=96.5%, DA=76.1% (heparin plasma) and SN=75%, SP=75.8%, PPV=26.1, NPV=96.4%, DA=75.7% (urine). Conclusion Blood and urine NGAL predicted stage 2/3 AKI, as well as persistent 2/3 AKI in the ICU with acceptable decision statistics using a single cut point in each type of specimen.

Original languageEnglish (US)
Article numbere016028
JournalBMJ Open
Volume7
Issue number7
DOIs
StatePublished - Jul 1 2017

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Acute Kidney Injury
Critical Illness
Multicenter Studies
Urine
Prospective Studies
Edetic Acid
Heparin
Sensitivity and Specificity
Intensive Care Units
Logistic Models
Lipocalin-2
Kidney Diseases
Observational Studies

Keywords

  • acute kidney injury
  • neutrophil gelatinase associated lipocalin
  • risk prediction
  • sensitivity
  • specificity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults : Retrospective determination and clinical validation of a prospective multicentre study. / Tecson, Kristen M.; Erhardtsen, Elisabeth; Eriksen, Peter M.; Gaber, A. Osama; Germain, Michael; Golestaneh, Ladan; De Los Angeles Lavoria, Maria; Moore, Linda W.; McCullough, Peter A.

In: BMJ Open, Vol. 7, No. 7, e016028, 01.07.2017.

Research output: Contribution to journalArticle

Tecson, Kristen M. ; Erhardtsen, Elisabeth ; Eriksen, Peter M. ; Gaber, A. Osama ; Germain, Michael ; Golestaneh, Ladan ; De Los Angeles Lavoria, Maria ; Moore, Linda W. ; McCullough, Peter A. / Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults : Retrospective determination and clinical validation of a prospective multicentre study. In: BMJ Open. 2017 ; Vol. 7, No. 7.
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title = "Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults: Retrospective determination and clinical validation of a prospective multicentre study",
abstract = "Objectives To determine the optimal threshold of blood and urine neutrophil gelatinase-associated lipocalin (NGAL) to predict moderate to severe acute kidney injury (AKI) and persistent moderate to severe AKI lasting at least 48 consecutive hours, as defined by an adjudication panel. Methods A multicentre prospective observational study enrolled intensive care unit (ICU) patients and recorded daily ethylenediaminetetraacetic acid (EDTA) plasma, heparin plasma and urine NGAL. We used natural log-transformed NGAL in a logistic regression model to predict stage 2/3 AKI (defined by Kidney Disease International Global Organization). We performed the same analysis using the NGAL value at the start of persistent stage 2/3 AKI. Results Of 245 subjects, 33 (13.5{\%}) developed stage 2/3 AKI and 25 (10.2{\%}) developed persistent stage 2/3 AKI. Predicting stage 2/3 AKI revealed the optimal NGAL cutoffs in EDTA plasma (142.0 ng/mL), heparin plasma (148.3 ng/mL) and urine (78.0 ng/mL) and yielded the following decision statistics: sensitivity (SN)=78.8{\%}, specificity (SP)=73.0{\%}, positive predictive value (PPV)=31.3{\%}, negative predictive value (NPV)=95.7{\%}, diagnostic accuracy (DA)=73.8{\%} (EDTA plasma); SN=72.7{\%}, SP=73.8{\%}, PPV=30.4{\%}, NPV=94.5{\%}, DA=73.7{\%} (heparin plasma); SN=69.7{\%}, SP=76.8{\%}, PPV=32.9{\%}, NPV=94{\%}, DA=75.8{\%} (urine). The optimal NGAL cutoffs to predict persistent stage 2/3 AKI were similar: 148.3 ng/mL (EDTA plasma), 169.6 ng/mL (heparin plasma) and 79.0 ng/mL (urine) yielding: SN=84.0{\%}, SP=73.5{\%}, PPV=26.6{\%}, NPV=97.6, DA=74.6{\%} (EDTA plasma), SN=84{\%}, SP=76.1{\%}, PPV=26.8{\%}, NPV=96.5{\%}, DA=76.1{\%} (heparin plasma) and SN=75{\%}, SP=75.8{\%}, PPV=26.1, NPV=96.4{\%}, DA=75.7{\%} (urine). Conclusion Blood and urine NGAL predicted stage 2/3 AKI, as well as persistent 2/3 AKI in the ICU with acceptable decision statistics using a single cut point in each type of specimen.",
keywords = "acute kidney injury, neutrophil gelatinase associated lipocalin, risk prediction, sensitivity, specificity",
author = "Tecson, {Kristen M.} and Elisabeth Erhardtsen and Eriksen, {Peter M.} and Gaber, {A. Osama} and Michael Germain and Ladan Golestaneh and {De Los Angeles Lavoria}, Maria and Moore, {Linda W.} and McCullough, {Peter A.}",
year = "2017",
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doi = "10.1136/bmjopen-2017-016028",
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volume = "7",
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TY - JOUR

T1 - Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults

T2 - Retrospective determination and clinical validation of a prospective multicentre study

AU - Tecson, Kristen M.

AU - Erhardtsen, Elisabeth

AU - Eriksen, Peter M.

AU - Gaber, A. Osama

AU - Germain, Michael

AU - Golestaneh, Ladan

AU - De Los Angeles Lavoria, Maria

AU - Moore, Linda W.

AU - McCullough, Peter A.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objectives To determine the optimal threshold of blood and urine neutrophil gelatinase-associated lipocalin (NGAL) to predict moderate to severe acute kidney injury (AKI) and persistent moderate to severe AKI lasting at least 48 consecutive hours, as defined by an adjudication panel. Methods A multicentre prospective observational study enrolled intensive care unit (ICU) patients and recorded daily ethylenediaminetetraacetic acid (EDTA) plasma, heparin plasma and urine NGAL. We used natural log-transformed NGAL in a logistic regression model to predict stage 2/3 AKI (defined by Kidney Disease International Global Organization). We performed the same analysis using the NGAL value at the start of persistent stage 2/3 AKI. Results Of 245 subjects, 33 (13.5%) developed stage 2/3 AKI and 25 (10.2%) developed persistent stage 2/3 AKI. Predicting stage 2/3 AKI revealed the optimal NGAL cutoffs in EDTA plasma (142.0 ng/mL), heparin plasma (148.3 ng/mL) and urine (78.0 ng/mL) and yielded the following decision statistics: sensitivity (SN)=78.8%, specificity (SP)=73.0%, positive predictive value (PPV)=31.3%, negative predictive value (NPV)=95.7%, diagnostic accuracy (DA)=73.8% (EDTA plasma); SN=72.7%, SP=73.8%, PPV=30.4%, NPV=94.5%, DA=73.7% (heparin plasma); SN=69.7%, SP=76.8%, PPV=32.9%, NPV=94%, DA=75.8% (urine). The optimal NGAL cutoffs to predict persistent stage 2/3 AKI were similar: 148.3 ng/mL (EDTA plasma), 169.6 ng/mL (heparin plasma) and 79.0 ng/mL (urine) yielding: SN=84.0%, SP=73.5%, PPV=26.6%, NPV=97.6, DA=74.6% (EDTA plasma), SN=84%, SP=76.1%, PPV=26.8%, NPV=96.5%, DA=76.1% (heparin plasma) and SN=75%, SP=75.8%, PPV=26.1, NPV=96.4%, DA=75.7% (urine). Conclusion Blood and urine NGAL predicted stage 2/3 AKI, as well as persistent 2/3 AKI in the ICU with acceptable decision statistics using a single cut point in each type of specimen.

AB - Objectives To determine the optimal threshold of blood and urine neutrophil gelatinase-associated lipocalin (NGAL) to predict moderate to severe acute kidney injury (AKI) and persistent moderate to severe AKI lasting at least 48 consecutive hours, as defined by an adjudication panel. Methods A multicentre prospective observational study enrolled intensive care unit (ICU) patients and recorded daily ethylenediaminetetraacetic acid (EDTA) plasma, heparin plasma and urine NGAL. We used natural log-transformed NGAL in a logistic regression model to predict stage 2/3 AKI (defined by Kidney Disease International Global Organization). We performed the same analysis using the NGAL value at the start of persistent stage 2/3 AKI. Results Of 245 subjects, 33 (13.5%) developed stage 2/3 AKI and 25 (10.2%) developed persistent stage 2/3 AKI. Predicting stage 2/3 AKI revealed the optimal NGAL cutoffs in EDTA plasma (142.0 ng/mL), heparin plasma (148.3 ng/mL) and urine (78.0 ng/mL) and yielded the following decision statistics: sensitivity (SN)=78.8%, specificity (SP)=73.0%, positive predictive value (PPV)=31.3%, negative predictive value (NPV)=95.7%, diagnostic accuracy (DA)=73.8% (EDTA plasma); SN=72.7%, SP=73.8%, PPV=30.4%, NPV=94.5%, DA=73.7% (heparin plasma); SN=69.7%, SP=76.8%, PPV=32.9%, NPV=94%, DA=75.8% (urine). The optimal NGAL cutoffs to predict persistent stage 2/3 AKI were similar: 148.3 ng/mL (EDTA plasma), 169.6 ng/mL (heparin plasma) and 79.0 ng/mL (urine) yielding: SN=84.0%, SP=73.5%, PPV=26.6%, NPV=97.6, DA=74.6% (EDTA plasma), SN=84%, SP=76.1%, PPV=26.8%, NPV=96.5%, DA=76.1% (heparin plasma) and SN=75%, SP=75.8%, PPV=26.1, NPV=96.4%, DA=75.7% (urine). Conclusion Blood and urine NGAL predicted stage 2/3 AKI, as well as persistent 2/3 AKI in the ICU with acceptable decision statistics using a single cut point in each type of specimen.

KW - acute kidney injury

KW - neutrophil gelatinase associated lipocalin

KW - risk prediction

KW - sensitivity

KW - specificity

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U2 - 10.1136/bmjopen-2017-016028

DO - 10.1136/bmjopen-2017-016028

M3 - Article

VL - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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ER -