Value of Plasma/Serum Neutrophil Gelatinase-Associated Lipocalin in Detection of Pediatric Acute Kidney Injury; a Systematic Review and Meta-Analysis

Background: Major attention has been drawn to the prognostic value of plasma/serum neutrophil gelatinase-associated lipocalin (NGAL) in detection of acute kidney injury (AKI) in children, but still no consensus has been reached. Accordingly, the present study aimed to assess the diagnostic value of this biomarker in detection of acute kidney injury in children through a systematic review and meta-analysis. Materials and Methods:  Two independent reviewers carried out a comprehensive search in electronic databases up to the end of August, 2016. After summarization of studies, screening performance characteristics of plasma/serum NGAL were evaluated in detection of AKI. The area under the curve of receiver operating characteristics curve, sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio of NGAL were calculated using a mixed-effects binary regression model. A p-value less than 0.05 was considered as significance threshold in all analyses. Results : Data from 22 studies (2,213 non-AKI children and 1,109 AKI patients) were pooled and analyzed. Analyses revealed that the performance of plasma/seum NGAL is maximal when the level of this biomarker is measured in the first 12 hours after admission or surgery, considering a cut-off level of 100 mg/dL. In this setting the area under the curve, sensitivity, specificity and diagnostic odds ratio of plasma/serum NGAL were 0.94 (95% CI: 0.91-0.95), 0.87 (95% CI: 0.67-0.96), 0.88 (95% CI: 0.65-0.96) and 48.05 (95% CI: 9.20-251.04), respectively. Conclusion: The high diagnostic value in the first few hours is one of the advantages of plasma/serum NGAL, emphasizing its usefulness in clinical evaluations.