Kidney Week

Abstract: FR-PO0384

Higher Urine Neutrophil Gelatinase-Associated Lipocalin Threshold Optimizes Prediction of New or Persistent Severe AKI in Children with Septic Shock

Session Information

• AKI: Biomarkers, Diagnostics, and Risk Prediction
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Clover-Brown, Imogen, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Imogen Clover-Brown, MD

• Standage, Stephen W., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Stephen W. Standage, MD

• Fuhrman, Dana Y., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Dana Y. Fuhrman, DO, MS

• Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Stuart Goldstein, MD, FASN

• Stanski, Natalja L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Natalja L. Stanski, MD, MS

Background

Urine neutrophil gelatinase-associated lipocalin (uNGAL) predicts severe, persistent acute kidney injury (AKI) in critically ill children, but optimal cutoffs in patients with sepsis, where increased systemic NGAL concentrations may alter performance, are unknown. We evaluated the predictive performance of uNGAL for new or persistent severe AKI in children with septic shock and whether the optimal cutoff is higher in this population.

Methods

Secondary analysis of an ongoing multicenter, prospective, observational cohort study of children (1 week-18 years) with septic shock. Patients with uNGAL data from the first 48 hours of admission were included (1/2020-3/2026). The primary outcome was Day 3 new or persistent severe AKI (SAKI; >KDIGO Stage 2). Area under the receiver operating characteristic (AUROC) and test characteristics were calculated at the general population cutoff (150 ng/mL) and compared to the Youden Index (YI)-derived optimal cutoff.

Results

Among 295 patients (median age 13.6 [IQR 6.9-17.5]; 131 (44%) female; 134 (45%) with Day 1 SAKI), median admission uNGAL was 369 [80-1752] ng/mL and 98 patients (33%) had new/persistent Day 3 SAKI. Patients with new/persistent SAKI had higher median uNGAL (1785 [470-3000] vs. 215 [61-579] ng/mL; p<0.001). uNGAL predicted Day 3 SAKI with AUROC 0.74 (95%CI: 0.68-0.81, p<0.001). Performance at the general population 150 ng/mL cutoff was: sensitivity 83%, specificity 41%, NPV 83% and PPV 41%. The optimal cutoff for prediction of new/persistent SAKI was 625 ng/mL (YI: 0.49). This cutoff improved specificity (77%) and PPV (61%), while maintaining NPV (83%) despite lower sensitivity (71%).

Conclusion

Admission uNGAL predicts new or persistent SAKI in children with septic shock with similar test characteristics as the general population, but a higher optimal cutoff provides better specificity and PPV. These data support the use of sepsis-specific uNGAL thresholds for clinical decision-making but require prospective validation.

Figure 1. ROC curve for uNGAL prediction of Day 3 new or persistent severe AKI in children with septic shock and test characteristics at select cutoffs

Funding

• Other NIH Support