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Review
. 2023 Mar 27:11:1147033.
doi: 10.3389/fped.2023.1147033. eCollection 2023.

Predictive value of neutrophil gelatinase-associated lipocalin in children with acute kidney injury: A systematic review and meta-analysis

Zhuan Zou  1   2 , Bin Chen  1   2 , Fajuan Tang  1   2 , Xihong Li  1   2 , Dongqiong Xiao  1   2
Affiliations
Review

Predictive value of neutrophil gelatinase-associated lipocalin in children with acute kidney injury: A systematic review and meta-analysis

Zhuan Zou et al. Front Pediatr. .

Abstract

Purpose: Neutrophil gelatin lipase carrier protein (NGAL) has been used as an early biomarker to predict acute kidney injury (AKI). However, the predictive value of NGAL in urine and blood in children with acute kidney injury in different backgrounds remains unclear. Therefore, we conducted this systematic review and meta-analysis to explore the clinical value of NGAL in predicting AKI in children.

Methods: Computerized databases were searched for relevant the studies published through August 4th, 2022, which included PUBMED, EMBASE, COCHRANE and Web of science. The risk of bias of the original included studies was assessed by using the Quality Assessment of Studies for Diagnostic Accuracy (QUADA-2). At the same time, subgroup analysis of these data was carried out.

Results: Fifty-three studies were included in this meta-analysis, involving 5,049 patients, 1,861 of whom were AKI patients. The sensitivity and specificity of blood NGAL for predicting AKI were 0.79 (95% CI: 0.69-0.86) and 0.85 (95% CI: 0.75-0.91), respectively, and SROC was 0.89 (95% CI: 0.86-0.91). The sensitivity and specificity of urine NGAL for predicting AKI were 0.83 (95% CI: 0.78-0.87) and 0.81 (95% CI: 0.77-0.85), respectively, and SROC was 0.89 (95% CI: 0.86-0.91). Meanwhile, the sensitivity and specificity of overall NGAL (urine and blood NGAL) for predicting AKI in children were 0.82 (95% CI: 0.77-0.86) and 0.82 (95% CI: 0.78-0.86), respectively, and SROC was 0.89 (95% CI: 0.86-0.91).

Conclusion: NGAL is a valuable predictor for AKI in children under different backgrounds. There is no significant difference in the prediction accuracy between urine NGAL and blood NGAL, and there is also no significant difference in different measurement methods of NGAL. Hence, NGAL is a non-invasive option in clinical practice. Based on the current evidence, the accuracy of NGAL measurement is the best at 2 h after cardiopulmonary bypass (CPB) and 24 h after birth in asphyxiated newborns.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022360157.

Keywords: acute kidney injury; children; meta-analysis; neutrophil gelatinase-associated lipocalin; predictive value.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of literature screening. AKI acute kidney injury, area under the AUC curve, NGAL neutrophil gelatin release-associated lipoprotein.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
(A) forest plot of overall sensitivity and specificity; (B) boxplot of overall heterogeneity; (C) overall SROC curve; (D) overall deeks funnel chart; (E) nomogram of overall clinical utility.
Figure 4
Figure 4
(A) sensitivity-specificity forest plot of blood NGAL; (B) heterogeneity—polygonal boxplot of blood NGAL; (C) SROC curve of blood NGAL; (D) deeks funnel diagram of blood NGAL; (E) clinical utility nomogram of blood NGAL.
Figure 5
Figure 5
(A) sensitivity-specificity forest plot of urine NGAL; (B) heterogeneity—polygonal boxplot of urine NGAL; (C) SROC curve of urine NGAL; (D) deeks funnel diagram of urine NGAL; (E) clinical utility nomogram of urine NGAL.
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