Neutrophil Gelatinase-Associated Lipocalin Cutoff Value Selection and Acute Kidney Injury Classification System Determine Phenotype Allocation and Associated Outcomes
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: We explored the extent to which neutrophil gelatinase-associated lipocalin (NGAL) cutoff value selection and the acute kidney injury (AKI) classification system determine clinical AKI-phenotype allocation and associated outcomes. Methods: Cutoff values from ROC curves of data from two independent prospective cardiac surgery study cohorts (Magdeburg and Berlin, Germany) were used to predict Kidney Disease: Improving Global Outcome (KDIGO)- or Risk, Injury, Failure, Loss of kidney function, End-stage (RIFLE)-defined AKI. Statistical methodologies (maximum Youden index, lowest distance to [0, 1] in ROC space, sensitivity≈specificity) and cutoff values from two NGAL meta-analyses were evaluated. Associated risks of adverse outcomes (acute dialysis initiation and in-hospital mortality) were compared. Results: NGAL cutoff concentrations calculated from ROC curves to predict AKI varied according to the statistical methodology and AKI classification system (10.6–159.1 and 16.85–149.3 ng/mL in the Magdeburg and Berlin cohorts, respectively). Proportions of attributed subclinical AKI ranged 2%–33.0% and 10.1%–33.1% in the Magdeburg and Berlin cohorts, respectively. The difference in calculated risk for adverse outcomes (fraction of odds ratios for AKI-phenotype group differences) varied considerably when changing the cutoff concentration within the RIFLE or KDIGO classification (up to 18.33- and 16.11-times risk difference, respectively) and was even greater when comparing cutoff methodologies between RIFLE and KDIGO classifications (up to 25.7-times risk difference). Conclusions: NGAL positivity adds prognostic information regardless of RIFLE or KDIGO classification or cutoff selection methodology. The risk of adverse events depends on the methodology of cutoff selection and AKI classification system.
Abstract
Background: We explored the extent to which neutrophil gelatinase-associated lipocalin (NGAL) cutoff value selection and the acute kidney injury (AKI) classification system determine clinical AKI-phenotype allocation and associated outcomes. Methods: Cutoff values from ROC curves of data from two independent prospective cardiac surgery study cohorts (Magdeburg and Berlin, Germany) were used to predict Kidney Disease: Improving Global Outcome (KDIGO)- or Risk, Injury, Failure, Loss of kidney function, End-stage (RIFLE)-defined AKI. Statistical methodologies (maximum Youden index, lowest distance to [0, 1] in ROC space, sensitivity≈specificity) and cutoff values from two NGAL meta-analyses were evaluated. Associated risks of adverse outcomes (acute dialysis initiation and in-hospital mortality) were compared. Results: NGAL cutoff concentrations calculated from ROC curves to predict AKI varied according to the statistical methodology and AKI classification system (10.6–159.1 and 16.85–149.3 ng/mL in the Magdeburg and Berlin cohorts, respectively). Proportions of attributed subclinical AKI ranged 2%–33.0% and 10.1%–33.1% in the Magdeburg and Berlin cohorts, respectively. The difference in calculated risk for adverse outcomes (fraction of odds ratios for AKI-phenotype group differences) varied considerably when changing the cutoff concentration within the RIFLE or KDIGO classification (up to 18.33- and 16.11-times risk difference, respectively) and was even greater when comparing cutoff methodologies between RIFLE and KDIGO classifications (up to 25.7-times risk difference). Conclusions: NGAL positivity adds prognostic information regardless of RIFLE or KDIGO classification or cutoff selection methodology. The risk of adverse events depends on the methodology of cutoff selection and AKI classification system.
참고문헌 (40)
- Hoste EAJ, "Epidemiology of acute kidney injury in critically ill patients : the multinational AKI-EPI study", Intensive Care Med, 41, pp.1411~1423 (2015)
- Nadim MK, "Cardiac and vascular surgery-associated acute kidney injury : the 20th International Consensus Conference of the ADQI(Acute Disease Quality Initiative)Group", J Am Heart Assoc, 7, pp.e008834~ (2018)
- Bellomo R, "Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs : the Second International Consensus Conference of the Acute Dialysis Quality Initiative(ADQI)Group", Crit Care, 8, pp.R204~12 (2004)
- Kidney Disease Improving Outcome, "KDIGO clinical practice guideline for acute kidney injury", Kidney Int Suppl, 2, pp.1~141 (2012)
- Albert C, "Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery", J Thorac Cardiovasc Surg, 155, pp.2441~2452 (2018)
- Di Somma S, "Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department", Crit Care, 17, pp.R29~ (2013)
- Nickolas TL, "Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage : a multicenter prospective cohort study", J Am Coll Cardiol, 59, pp.246~255 (2012)
- Christian Albert, "Urinary Biomarkers may Complement the Cleveland Score for Prediction of Adverse Kidney Events After Cardiac Surgery: A Pilot Study", Annals of Laboratory Medicine, 40(2), pp.131~141 (2020), 대한진단검사의학회[DOI]
- Albert C, "Neutrophil gelatinase-associated lipocalin measured on clinical laboratory platforms for the prediction of acute kidney injury and the associated need for dialysis therapy : a systematic review and meta-analysis", Am J Kidney Dis, 76, pp.826~841 (2020)
- Ostermann M, "Recommendations on acute kidney injury biomarkers from the acute disease quality initiative consensus conference : a consensus statement", JAMA Netw Open, 3, pp.e2019209~ (2020)
- Habibzadeh F, "On determining the most appropriate test cut-off value : the case of tests with continuous results", Biochem Med, 26, pp.297~307 (2016)
- Cho E, "The incidence and risk factors of acute kidney injury after hepatobiliary surgery : a prospective observational study", BMC Nephrol, 15, pp.169~ (2014)
- Yang CH, "Combination of urinary biomarkers improves early detection of acute kidney injury in patients with heart failure", Circ J, 80, pp.1017~1023 (2016)
- Rozenfeld KL, "Elevated neutrophil gelatinase-associated lipocalin for the assessment of structural versus functional renal damage among ST-segment elevation myocardial infarction patients", Blood Purif, 49, pp.560~566 (2020)
- Pickering JW, "Linking injury to outcome in acute kidney injury : a matter of sensitivity", PLoS One, 8, pp.e62691~ (2013)
- Albert Christian, "Biomarker-Guided Risk Assessment for Acute Kidney Injury: Time for Clinical Implementation?", Annals of Laboratory Medicine, 41(1), pp.1~15 (2021), 대한진단검사의학회[DOI]
- Haase M, "Prophylactic perioperative sodium bicarbonate to prevent acute kidney injury following open heart surgery : a multicenter double-blinded randomized controlled trial", PLoS Med, 10, pp.e1001426~ (2013)
- Albert C, "Urinary neutrophil gelatinase-associated lipocalin-guided risk assessment for major adverse kidney events after open-heart surgery", Biomark Med, 12, pp.975~985 (2018)
- Grenier FC, "Evaluation of the ARCHITECT urine NGAL assay: assay performance, specimen handling requirements and biological variability", Clin Biochem, 43, pp.615~620 (2010)
- Hanley JA, "The meaning and use of the area under a receiver operating characteristic(ROC)curve", Radiology, 143, pp.29~36 (1982)
- Waikar SS, "Imperfect gold standards for kidney injury biomarker evaluation", J Am Soc Nephrol, 23, pp.13~21 (2012)
- Haase M, "The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury : a multicenter pooled analysis of prospective studies", J Am Coll Cardiol, 57, pp.1752~1761 (2011)
- Youden WJ, "Index for rating diagnostic tests", Cancer, 3, pp.32~35 (1950)
- Perkins NJ, "The inconsistency of"optimal"cutpoints obtained using two criteria based on the receiver operating characteristic curve", Am J Epidemiol, 163, pp.670~675 (2006)
- Haase M, "Accuracy of neutrophil gelatinase-associated lipocalin(NGAL)in diagnosis and prognosis in acute kidney injury : a systematic review and meta-analysis", Am J Kidney Dis, 54, pp.1012~1024 (2009)
- "R: A language and environment for statistical computing" (2023)[URL]
- Singer E, "Urinary neutrophil gelatinase-associated lipocalin distinguishes pre-renal from intrinsic renal failure and predicts outcomes", Kidney Int, 80, pp.405~414 (2011)
- O’Neal JB, "Acute kidney injury following cardiac surgery : current understanding and future directions", Crit Care, 20, pp.187~ (2016)
- Thiele RH, "AKI associated with cardiac surgery", Clin J Am Soc Nephrol, 10, pp.500~514 (2015)
- Brenner H, "Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence", Stat Med, 16, pp.981~991 (1997)
- Cook NR, "Use and misuse of the receiver operating characteristic curve in risk prediction", Circulation, 115, pp.928~935 (2007)
- Rodrigues CE, "Definitions, phenotypes, and subphenotypes in acute kidney injury-moving towards precision medicine", Nephrology, 28, pp.83~96 (2023)
- Huen SC, "Molecular phenotyping of clinical AKI with novel urinary biomarkers", Am J Physiol Renal Physiol, 309, pp.F406~13 (2015)
- Kellum JA, "What can we expect from biomarkers for acute kidney injury?", Biomark Med, 8, pp.1239~1245 (2014)
- Zapf A, "Meta-analysis of diagnostic accuracy studies with multiple thresholds : comparison of different approaches", Biom J, 63, pp.699~711 (2021)
- Jäntti T, "Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock", Ann Intensive Care, 11, pp.25~ (2021)
- Kim H, "Plasma neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in critically ill patients with suspected sepsis", Clin Biochem, 46, pp.1414~1418 (2013)
- L’Acqua C, "Nephrocheck after cardiac surgery: does it play a role in daily practice? A sequel of “Nephrocheck results should be corrected for dilution.”", Int J Artif Organs, 42, pp.665~667 (2019)
- Albert Christian, "Predictive Value of Plasma NGAL:Hepcidin-25 for Major Adverse Kidney Events After Cardiac Surgery with Cardiopulmonary Bypass: A Pilot Study", Annals of Laboratory Medicine, 41(4), pp.357~365 (2021), 대한진단검사의학회[DOI]
- Greenland S, "Avoiding power loss associated with categorization and ordinal scores in dose-response and trend analysis", Epidemiology, 6, pp.450~454 (1995)