Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine (sCr) for acute kidney injury (AKI) diagnosis

Abstract

IntroductionUrine neutrophil gelatinase-associated lipocalin (uNGAL) is a sensitive and specific diagnostic test for acute kidney injury (AKI) in the Emergency Department (ED), but its economic impact has not been investigated. We hypothesized that uNGAL used in combination with serum creatinine (sCr) would reduce costs in the management of AKI in patients presenting to the ED in comparison to using sCr alone.Materials and methodsA cost simulation model was developed for clinical algorithms to diagnose AKI based on sCr alone vs. uNGAL plus sCr (uNGAL+sCr). A cost minimization analysis was performed to determine total expected costs for patients with AKI. uNGAL test characteristics were validated with eight-hundred forty-nine patients with sCr ≥1.5 from a completed study of 1635 patients recruited from EDs at two U.S. hospitals from 2007–8. Biomarker test, AKI work-up, and diagnostic imaging costs were incorporated.ResultsFor a hypothetical cohort of 10,000 patients, the model predicted that the expected costs were $900 per patient (pp) in the sCr arm and $950 in the uNGAL+sCr arm. uNGAL+sCr resulted in 1,578 fewer patients with delayed diagnosis and treatment than sCr alone (2,013 vs. 436 pts) at center 1 and 1,973 fewer patients with delayed diagnosis and treatment than sCr alone at center 2 (2,227 vs. 254 patients). Although initial evaluation costs at each center were $50 pp higher in with uNGAL+sCr, total costs declined by $408 pp at Center 1 and by $522 pp at Center 2 due to expected reduced delays in diagnosis and treatment. Sensitivity analyses confirmed savings with uNGAL + sCr for a range of cost inputs.DiscussionUsing uNGAL with sCr as a clinical diagnostic test for AKI may improve patient management and reduce expected costs. Any cost savings would likely result from avoiding delays in diagnosis and treatment and from avoidance of unnecessary testing in patients given a false positive AKI diagnosis by use of sCr alone.

Acute kidney injury risk in orthopaedic trauma patients pre and post surgery using a biomarker algorithm and clinical risk score

“…H-FABP, associated with cardiac injury, is released into the bloodstream 30 min after an ischaemic event and peaks at 6 h before returning to normal levels after 24 h 32 . H-FABP has been reported to predict AKI pre and post cardiac surgery 7,11,33 however, this is the first time that H-FABP has been demonstrated to predict AKI in patients pre and post ORIF surgery. H-FABP is predominantly expressed in the heart but also at lower levels in skeletal muscle, kidney, stomach, brain and testis 34,35 .…”

“…Creatinine measured in serum or plasma is the most commonly used biomarker to determine estimated glomerular filtration rate (eGFR). However, an increase in creatinine levels after renal insult is often delayed and a change in plasma creatinine levels may not be evident until two to three days after the initial insult 7 . Work in animals and humans has shown that although AKI due to ischemia can be prevented and treated, preventative therapy must be started very early after the renal injury 8 .…”

A decision support system for the prediction of mortality in patients with acute kidney injury admitted in intensive care unit

“…Various studies (Gungor et al, 2014;Haase et al, 2009;Ralib et al, 2014;Shyam et al, 2017;Wang et al, 2014;Yang et al, 2014) have demonstrated that NGAL could be used in the prediction of mortality. Parikh et al (2017) showed that there is a considerable increase in the NGAL levels after shock (circulatory) in the patients undergoing intensive care. It was stated that NGAL could be used for predicting the development of AKI before one to three days according to creatinine level; therefore, it would serve as a suitable early descriptive biomarker for AKI.…”

Early Diagnosis and Prognostic Value of Acute Kidney Injury in Critically Ill Patients

“…The administration of nephrotoxic medications in such patients is discontinued, fluid overload is avoided, and early decision on the indications for the initiation of renal replacement therapy is taken if the sCr level rises as well [5]. Early recognition of renal damage, application of preventive measures, and initiation of adequate treatment are of crucial importance in order to avoid the development of AKI, to reduce pediatric mortality and treatment costs, and to improve disease outcomes [5,36].…”