Clinical Implementation of Urinary Neutrophil Gelatinase-Associated Lipocalin Testing for Diagnosing Acute Kidney Injury in an Academic Tertiary Care Medical Centre
Notice bibliographique
Résumé
Key Points Urinary neutrophil gelatinase-associated lipocalin is a sensitive urinary biomarker in the differentiation of intrinsic (intrarenal) AKI from nonintrinsic (prerenal and postrenal) AKI. Urinary neutrophil gelatinase-associated lipocalin in addition to fractional excretion of urinary sodium and serum creatinine improves accuracy in differentiating intrinsic from nonintrinsic AKI. Background Differentiating functional AKI from structural/intrinsic AKI with tubular injury remains a clinical challenge. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has shown promise in distinguishing these conditions. This study evaluated the implementation of uNGAL in a heterogeneous medical cohort at an academic tertiary care center in Ireland over a 3-year period. Methods A retrospective audit was conducted from 2020 to 2023. Standard clinical data around the time of AKI and uNGAL request were recorded. Blinded case adjudication of the differential diagnosis of AKI cause using the standard clinical information (but not urine neutrophil gelatinase-associated lipocalin results) was performed by two expert nephrologists. Analysis of uNGAL focused on the accuracy in differentiating adjudicated (intrarenal) AKI from nonintrinsic AKI (prerenal and postrenal). Results A total of 323 uNGAL tests were performed, with 292 AKI cases adjudicated. Intrinsic AKI cases had significantly higher uNGAL and uNGAL/creatinine ratio (uNGAL/Cr) levels than nonintrinsic cases ( P < 0.001), including after excluding urinary tract infection cases. uNGAL (area under the receiver operation curve [AUC], 0.71; 95% confidence interval [CI], 0.65 to 0.77) and uNGAL/Cr (AUC, 0.73; 95% CI, 0.67 to 0.79) showed moderate discriminative performance. uNGAL (threshold [Thr] 150 ng/ml) had high sensitivity (0.87) and negative predictive value (0.82). uNGAL/Cr was similar at the 288 ng/mg Thr. Discriminative performance improved for uNGAL and uNGAL/Cr, but not for serum creatinine, fractional excretion of urinary sodium, or serum urea, after excluding urinary tract infection cases. Both uNGAL (adjusted odds ratios, 2.05; 95% CI, 1.59 to 2.71) and uNGAL/Cr (adjusted odds ratios, 2.07; 95% CI, 1.64 to 2.68) were independently associated with intrinsic AKI. Adding these biomarkers to a logistic regression model significantly improved discrimination performance (AUC, 0.79; 95% CI, 0.76 to 0.84; P = 0.0116). Conclusions The use of uNGAL improved the discriminative accuracy of differential diagnosis of AKI in clinical practice by differentiating intrinsic AKI from nonintrinsic. Specificity was low at the manufacturer's recommended Thr (150 ng/ml), but the sensitivity and negative predictive value were high in all analyses. These findings support the clinical utility of uNGAL at the 150 ng/ml Thr as a “rule-out” test for intrinsic AKI, thereby helping to direct management toward functional (prerenal) or obstructive (postrenal) causes when uNGAL is negative.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».