Neutrophil gelatinase-associated lipocalin in contrast-induced acute kidney injury post cardiac procedure: a systematic review

Document Type

Review

Publication Date

6-1-2026

Abstract

Background Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker for the early diagnosis of contrast-induced acute kidney injury (CI-AKI) after coronary angiography (CAG) or percutaneous coronary intervention (PCI), but its diagnostic performance varies widely. NGAL may also predict adverse outcomes such as the need for renal replacement therapy (RRT), the length of hospital stay, and mortality. Objective This systematic review assessed the diagnostic performance of NGAL versus serum creatinine for early diagnosis of CI-AKI in adults undergoing CAG/PCI and evaluated its prognostic value for clinical outcomes. Methods Following a registered protocol (PROSPERO: CRD42023475660), databases were searched until November 1, 2023. Twenty studies were included. Diagnostic data were narratively synthesised; prognostic outcomes were not synthesised due to insufficient data. Results In 20 studies (n = 4172 patients, 3882 with NGAL measurements), 433 developed CI-AKI (11.2%). Diagnostic accuracy varied by protocol: serum/plasma NGAL 2–6 h post-contrast had higher specificity, while urinary NGAL 6–24 h post-contrast showed greater sensitivity. Dynamic measurements such as ΔuNGAL (0–6 h ≥ 121 ng/mL; AUC 0.93) and a ≥ 49% increase in serum NGAL at 24 h (AUC 0.899) were crucial for accuracy in chronic kidney disease (CKD) patients. NGAL consistently demonstrated excellent negative predictive values (90–100%), supporting its rule-out utility. The prognostic value of NGAL was reported inconsistently, which precluded the synthesis of associations with the need for RRT, the length of the hospital stays, and mortality. Conclusion NGAL is a clinically useful, protocol-dependent biomarker for ruling out CI-AKI. Standardisation of the matrix, timing, and dynamic measurement, especially in CKD, is essential for reliable implementation. Future multicentre prospective studies employing standardised NGAL protocols and consistent definitions of CI-AKI are essential to validate its diagnostic utility.

Keywords

(CI-AKI), Biomarker, Contrast-induced acute kidney injury, Coronary angiography (CAG), Diagnostic performance, Neutrophil gelatinase-associated lipocalin (NGAL), Percutaneous coronary intervention (PCI)

Publication Title

Clinica Chimica Acta

ISSN

0009-8981

DOI

10.1016/j.cca.2026.120977

Volume

588

Publisher

Elsevier

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