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Dr. Marlies Ostermann – published an interesting article i CC-news on Biomarkers in general (and NGAL in particular) Biomarkers of acute kidney injury: where are we now?
The article gives a comprehensive overview of the present situation. Dr. Marlies Ostermann – Biomarkers where are we ?
Dr. Marlies have earlier compared NGAL to Troponin – in a article we have previously discussed here at medicoinvestor: http://medicoinvestor.com/is-ngal-the-troponin-of-the-kidney/
in the recent article Dr. Ostermann focuses on the poor predictability of NGAL – as demonstrated in the study by De Geus on 510 patients – where adding the results to a clinical prediction model, only led to marginal improvement of the area under the receiver operating characteristics curve (AUC) from 0.79 to 0.82.
The reason for this is – in my humble opinion – again the cutoff-values. If set too low the “hit-rate” drops. This is of course also noticed by Dr. Ostermann who later in the article concludes: “In conclusion, the diagnostic utility of NGAL or other biomarkers to diagnose AKI prior to elevations in creatinine varies between different patient populations and is affected by comorbidity, timing of the measurements and, importantly, the chosen cutoff values. Herein lies one of the fundamental problems besetting the evaluation and interpretation of any new biomarker for AKI”
The whole article is interesting – not only because NGAL is mentioned most of all the relevant biomarkers – but also because its a summary of the obstacles yet to overcome.
To me the most pressing obstacle is the cut-off. Once we see universal acknowledgement of the right cutoff (and we all know what that is) – then we can see rapid expansion. But given the limited ressources of BioPorto that is not likely to happen until AFTER one of the global players that BioPorto is negotiating with, decides to market the NGAL-test actively
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