ArticleChildhood kidney diseases2025
Comparative diagnostic value of NGAL and multibiomarker models in pediatric sepsis-associated acute kidney injury in Indonesia: a preliminary study.
Article in Childhood kidney diseases, 2025. 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
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 ( 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.
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