ArticleCardiorenal medicine2026
Indexed Neutrophil Gelatinase-Associated Lipocalin: Improving Prediction and Ruling Out of Contrast-Induced Nephropathy.
Article in Cardiorenal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe risk for contrast-induced acute kidney injury (CI-AKI) following cardiac procedures involving contrast administration is particularly high among chronic kidney disease (CKD) patients. Neutrophil gelatinase-associated lipocalin (NGAL) has been widely studied as an early marker for renal injury. However, CKD could impact NGAL levels and alter their predictive performance. This study aimed to evaluate a novel baseline "indexed NGAL" (I-NGAL), calculated by adjusting NGAL to the estimated glomerular filtration rate (eGFR), for the prediction of CI-AKI in CKD patients undergoing elective transcatheter aortic valve replacement (TAVR).
methodsA total of 134 CKD patients undergoing elective TAVR were included. Serum NGAL levels were drawn at hospital admission. Patients were followed for the occurrence of CI-AKI. Receiver-operator characteristic methods were used to identify optimal sensitivity and specificity for I-NGAL. Univariate and multivariate binary logistic regression models were used to assess I-NGAL predictive performance.
resultsOverall, 35/134 patients (26%) developed CI-AKI following TAVR; both NGAL and I-NGAL were significantly higher among patients having CI-AKI. I-NGAL results had a higher predictive ability than unindexed NGAL results (AUC of 0.83 vs. 0.78, p < 0.001). The optimal I-NGAL cutoff for prediction of CI-AKI was 4, with a sensitivity of 71%, a specificity of 77%, and a negative predictive value of 88%. In a multivariate logistic regression model, I-NGAL was independently associated with CI-AKI (OR 1.22, 95% CI: 1.05-1.41; p = 0.007). I-NGAL level >4 was also independently associated with CI-AKI (OR 8.13, 95% CI 3-21.8, p < 0.001).
conclusionAmong CKD patients undergoing elective TAVR, adjusting baseline NGAL values according to eGFR yields an I-NGAL that serves as an improved tool for predicting and ruling out CI-AKI, regardless of baseline renal function.
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