Evidence map›Paper›PMID 41690641›Full record

ArticleInternational journal of antimicrobial agents2026

Urine NGAL adds to serum creatinine in predicting cefepime clearance in critically ill children at high risk of acute kidney injury.

Horace Rhodes Hambrick, Ronaldo Morales Junior, Calise Curry, Michaela Collins, Luana Johnson, Tomoyuki Mizuno, Kelli A Krallman, Stuart L Goldstein, Sonya Tang Girdwood

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of antimicrobial agents, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Horace Rhodes HambrickDivision of Nephrology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Ronaldo Morales JuniorDivision of Translational and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Calise CurryDivision of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Michaela CollinsCenter for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Luana JohnsonCenter for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Tomoyuki MizunoDivision of Translational and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Kelli A KrallmanCenter for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Stuart L GoldsteinCenter for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Sonya Tang GirdwoodDivision of Translational and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: sonya.tanggirdwood@cchmc.org.

Funding

Antibiotic Model-Informed Precision Dosing in Critical IllnessR35GM146701 · CINCINNATI CHILDRENS HOSP MED CTR · 2025 to 2025
$398k
RESEARCH TRAINING IN PEDIATRIC NEPHROLOGYT32DK007695 · CHILDREN'S HOSPITAL MED CTR (CINCINNATI) · 1992 to 2002
$217k
NIDDK NIH HHS T32 DK007695NIGMS NIH HHS R35 GM146701
6 · The paper itself

Abstract

introductionCefepime clearance (CL) depends on renal function, but serum creatinine (SCr) lags behind real-time changes in kidney function. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker of real-time tubular injury, though its role in predicting cefepime pharmacokinetics (PK) is unclear.

methodsWe conducted a prospective study in paediatric intensive care unit (PICU) patients at high risk for acute kidney injury who received cefepime within 48 h of admission and had uNGAL measured. A validated population PK model incorporating SCr-estimated GFR (eGFR) was adapted to test the added predictiveness of uNGAL. Inter-occasion variability (IOV) assessed whether CL and central volume (V1) differed after 48 h of PICU admission. Monte Carlo simulations (n = 10 000) evaluated the probability of pharmacodynamic (PD) target attainment (PTA) for various cefepime regimens and PK/PD targets across weight groups (5-40 vs. 40-100 kg), kidney function strata (eGFR 30-60, 60-90, 90-150 mL/min/1.73m²), and uNGAL thresholds (≥500 vs. <500 ng/mL).

resultsFifty patients (median age 11.5 y) were enrolled. PICU admission uNGAL ≥500 ng/mL was associated with ∼35% lower CL, independent of eGFR, with IOV at 4 h post-PICU admission significant for CL and V1. Patients with low uNGAL had higher CL at a given eGFR with consequently lower PTA for a given dosing regimen, necessitating extended or continuous infusions to reach PK/PD targets.

conclusionsIntegrating uNGAL improves the prediction of cefepime CL beyond SCr alone. Patients with low uNGAL despite elevated SCr risked subtherapeutic exposure. Urine biomarker-guided dosing may help optimise PTA and warrants further study.

Indexed as

Acute Kidney InjuryAnti-Bacterial AgentsCefepimeCreatinineLipocalin-2SerumAdolescentBiomarkersChildChild, PreschoolCritical IllnessFemaleHumansInfantIntensive Care Units, PediatricMaleAnti-Bacterial AgentsBiomarkersCefepimeCreatinineLCN2 protein, humanLipocalin-2Third Generation CephalosporinsAcute kidney injuryBeta-lactam pharmacokineticsModel-informed precision dosingMonte Carlo simulationsUrine biomarkers

Identifiers

PMID41690641
PMCPMC13325201

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.