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Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort
INTRODUCTION: Acute kidney injury (AKI) is a major cause of mortality worldwide, particularly in low-resource settings with limited diagnostic testing. Neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in predicting AKI. Nested within a larger, prospective cohort study evaluating A...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569698/ https://www.ncbi.nlm.nih.gov/pubmed/33102973 http://dx.doi.org/10.1016/j.ekir.2020.07.019 |
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author | Bjornstad, Erica C. Muronya, William Kamija, Manly Smith, Zachary Munthali, Charles K. Gibson, Keisha Mottl, Amy K. Charles, Anthony Marshall, Stephen W. Golightly, Yvonne M. Gower, Emily W. |
author_facet | Bjornstad, Erica C. Muronya, William Kamija, Manly Smith, Zachary Munthali, Charles K. Gibson, Keisha Mottl, Amy K. Charles, Anthony Marshall, Stephen W. Golightly, Yvonne M. Gower, Emily W. |
author_sort | Bjornstad, Erica C. |
collection | PubMed |
description | INTRODUCTION: Acute kidney injury (AKI) is a major cause of mortality worldwide, particularly in low-resource settings with limited diagnostic testing. Neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in predicting AKI. Nested within a larger, prospective cohort study evaluating AKI incidence in admitted trauma patients, our objective was to evaluate a novel dipstick, NGALds, for the prediction of AKI in Malawi, Africa. METHODS: Participants were >6 months of age. Spearman rank correlation coefficients (R) assessed NGAL categories (negative [≤50 ng/ml], low risk [51−149 ng/ml], moderate risk [150−299 ng/ml], and high risk [≥300 ng/ml]) for the urine NGALds dipstick and laboratory-based NGAL Test. RESULTS: We enrolled 285 participants (one-third children). Thirteen percent developed AKI. The dipstick captured 45 of 52 participants (86.5%) with moderate- or high-risk NGAL values on laboratory-based testing (R = 0.74). The dipstick had sensitivity of 44.4%, specificity of 73.5%, positive predictive value of 19.5%, and negative predictive value of 90.2% for predicting AKI. Acute kidney injury was associated with an increased risk of mortality (relative risk [RR] = 3.9, 95% confidence interval [CI] = 1.9−8.2), but mortality risk greatly increased among children who first had a positive (≥150 ng/ml) NGALds result (RR = 12.0, 95% CI = 1.8−78.4). CONCLUSIONS: The NGALds dipstick performed similarly to the NGAL Test in this low-resource setting and may be a useful tool to rule out AKI. It may be even more important in predicting high mortality risk among children. |
format | Online Article Text |
id | pubmed-7569698 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-75696982020-10-23 Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort Bjornstad, Erica C. Muronya, William Kamija, Manly Smith, Zachary Munthali, Charles K. Gibson, Keisha Mottl, Amy K. Charles, Anthony Marshall, Stephen W. Golightly, Yvonne M. Gower, Emily W. Kidney Int Rep Clinical Research INTRODUCTION: Acute kidney injury (AKI) is a major cause of mortality worldwide, particularly in low-resource settings with limited diagnostic testing. Neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in predicting AKI. Nested within a larger, prospective cohort study evaluating AKI incidence in admitted trauma patients, our objective was to evaluate a novel dipstick, NGALds, for the prediction of AKI in Malawi, Africa. METHODS: Participants were >6 months of age. Spearman rank correlation coefficients (R) assessed NGAL categories (negative [≤50 ng/ml], low risk [51−149 ng/ml], moderate risk [150−299 ng/ml], and high risk [≥300 ng/ml]) for the urine NGALds dipstick and laboratory-based NGAL Test. RESULTS: We enrolled 285 participants (one-third children). Thirteen percent developed AKI. The dipstick captured 45 of 52 participants (86.5%) with moderate- or high-risk NGAL values on laboratory-based testing (R = 0.74). The dipstick had sensitivity of 44.4%, specificity of 73.5%, positive predictive value of 19.5%, and negative predictive value of 90.2% for predicting AKI. Acute kidney injury was associated with an increased risk of mortality (relative risk [RR] = 3.9, 95% confidence interval [CI] = 1.9−8.2), but mortality risk greatly increased among children who first had a positive (≥150 ng/ml) NGALds result (RR = 12.0, 95% CI = 1.8−78.4). CONCLUSIONS: The NGALds dipstick performed similarly to the NGAL Test in this low-resource setting and may be a useful tool to rule out AKI. It may be even more important in predicting high mortality risk among children. Elsevier 2020-07-25 /pmc/articles/PMC7569698/ /pubmed/33102973 http://dx.doi.org/10.1016/j.ekir.2020.07.019 Text en © 2020 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Bjornstad, Erica C. Muronya, William Kamija, Manly Smith, Zachary Munthali, Charles K. Gibson, Keisha Mottl, Amy K. Charles, Anthony Marshall, Stephen W. Golightly, Yvonne M. Gower, Emily W. Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort |
title | Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort |
title_full | Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort |
title_fullStr | Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort |
title_full_unstemmed | Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort |
title_short | Validity of Urine NGALds Dipstick for Acute Kidney Injury in a Malawian Trauma Cohort |
title_sort | validity of urine ngalds dipstick for acute kidney injury in a malawian trauma cohort |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569698/ https://www.ncbi.nlm.nih.gov/pubmed/33102973 http://dx.doi.org/10.1016/j.ekir.2020.07.019 |
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