Comparative diagnostic value of NGAL and multibiomarker models in pediatric sepsis-associated acute kidney injury in Indonesia: a preliminary study

Abstract

Purpose: Sepsis is a leading cause of pediatric critical illness and a major contributor to acute kidney injury (AKI). Sepsis-associated AKI (SA-AKI) worsens outcomes, yet current diagnostic criteria based on serum creatinine and urine output lack sensitivity for early detection. This study evaluated the diagnostic performance of neutrophil gelatinase-associated lipocalin (NGAL), angiopoietin- 2, and syndecan-1 for early identification of SA-AKI in children with sepsis.Methods: A prospective nested case-control study was conducted in children aged 1–18 years with sepsis. Participants were classified into SA-AKI and non-SA-AKI groups using pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria based on estimated creatinine clearance index (eCCI). Blood and urine samples were collected at baseline, 12, 24, and 48 hours to measure NGAL, angiopoietin-2, and syndecan-1 levels by enzyme-linked immunosorbent assay. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis.Results: Of 23 children enrolled, eight (34.8%) developed SA-AKI. Baseline creatinine, eCCI, urinary NGAL, and mean corpuscular volume (MCV) differed significantly between groups, whereas angiopoietin-2 and syndecan-1 did not. ROC analysis showed that 24-hour eCCI (area under the curve [AUC]=1.000; sensitivity 100%; specificity 100%) and 12- to 24-hour urinary NGAL (AUC=0.900; sensitivity 87.5%; specificity 86.7%) were the strongest predictors. MCV had moderate accuracy (AUC=0.767). Urinary NGAL correlated negatively with eCCI (r=−0.67).Conclusions: Urinary NGAL measured within 12–24 hours is a reliable early biomarker for SA-AKI in pediatric sepsis, complementing eCCI and pRIFLE criteria to enhance early diagnosis and management.