Wetterstrand Vicky Jenny Rebecka, Schultz Martin, Kallemose Thomas, Torre André, Larsen Jesper Juul, Friis-Hansen Lennart, Brandi Lisbet
Department of Clinical Biochemistry, North Zealand University Hospital, Denmark.
Department of Geriatrics, Herlev University Hospital, Herlev, Denmark.
PLoS One. 2025 Jan 10;20(1):e0316897. doi: 10.1371/journal.pone.0316897. eCollection 2025.
Acute kidney injury (AKI) is a syndrome with high mortality and morbidity in part due to delayed recognition based on changes in creatinine. A marker for AKI based on a single measurement is needed and therefore the performance of a single measurement of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict AKI in patients admitted to the emergency department was tested.
Samples from the Triage study which included 6005 consecutive adult patients admitted to the emergency department were tested for pNGAL. The optimal cutoff for pNGAL was determined by the AUC and compared to AKI based on creatinine using different estimations of the premorbid kidney function.
In 4833 patients, two or more plasma creatinine (pCr) measurements were available allowing the detection of AKI. The highest prevalence of AKI (10%) was found when defining AKI as an increase in pCr ≥26.5 μmol/L from the prior year's mean pCr. At these conditions the AUC for pNGAL to predict AKI was 85% giving an optimal cutoff of 142.5 ng/mL with a negative predictive value of 0.96, a positive predictive value of 0.35, a specificity of 0.87 and a sensitivity of 0.70.
The study illustrates that the value of a single measurement of pNGAL is primarily in excluding AKI whereas it`s poorer in predicting the presence of AKI. When diagnosing AKI with pCr the optimal baseline pCr level is the mean of available pCr (mb-pCr) measurements from up to a year prior to the current event.
急性肾损伤（AKI）是一种死亡率和发病率都很高的综合征，部分原因是基于肌酐变化的诊断延迟。因此需要一种基于单次测量的AKI标志物，为此对急诊入院患者单次测量血浆中性粒细胞明胶酶相关脂质运载蛋白（pNGAL）以预测AKI的性能进行了测试。
对分诊研究中的样本进行pNGAL检测，该研究纳入了6005例连续入住急诊科的成年患者。通过曲线下面积（AUC）确定pNGAL的最佳临界值，并与基于肌酐的AKI进行比较，同时使用不同的病前肾功能估计方法。
在4833例患者中，可以获得两次或更多次血浆肌酐（pCr）测量值，从而能够检测出AKI。当将AKI定义为pCr较上一年平均pCr升高≥26.5μmol/L时，发现AKI患病率最高（10%）。在这些条件下，pNGAL预测AKI的AUC为85%，最佳临界值为142.5 ng/mL，阴性预测值为0.96，阳性预测值为0.35，特异性为0.87，敏感性为0.70。
该研究表明，单次测量pNGAL的价值主要在于排除AKI，而在预测AKI的存在方面较差。当用pCr诊断AKI时，最佳基线pCr水平是当前事件发生前长达一年的可用pCr（mb-pCr）测量值的平均值。
