Diagnostic accuracy of Neutrophil Gelatinase-Associated Lipocalin (NGAL) for inflammatory bowel disease: a systematic review and bivariate diagnostic meta-analysis.
- 1Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- 2Department of Traditional Chinese Medicine, Jinshan Hospital, Fudan University, Shanghai, 200540, China.
- 3Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China. [email protected].
Abstract
Objective
To systematically assess the diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) for inflammatory bowel disease (IBD) and to compare its performance with fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) using marker-specific diagnostic test accuracy meta-analysis.Methods
PubMed, Embase, and the Cochrane Library were searched for diagnostic studies using endoscopy and/or histopathology as the reference standard. The primary synthesis used directly reported complete four-cell table data and marker-specific bivariate random-effects models (Reitsma). Exploratory analyses using sensitivity/specificity records were performed only as supplementary checks because patient populations, thresholds, sample types, and reference standards were not sufficiently exchangeable for a formal diagnostic network meta-analysis. Subgroup feasibility, direct-data sensitivity checks, continuity correction use, and Deeks funnel plot asymmetry were assessed.Results
Seventy-eight studies with 148 diagnostic records were included. The primary bivariate analysis was based on 27 directly reported complete four-cell records, including 11 FC, 7 CRP, 5 ESR, and 4 NGAL records; 85 sensitivity/specificity records were used only for supplementary exploratory analyses. NGAL showed a pooled sensitivity of 90.9% (95% CI: 66.1%-98.1%) and specificity of 76.1% (95% CI: 42.4%-93.2%), but the estimate was imprecise and underpowered because only 13 NGAL records and 4 complete four-cell records were available. Exploratory network diagnostics did not support clinically interpretable ranking.Conclusion
NGAL may have high sensitivity for IBD diagnosis, but current evidence is preliminary, heterogeneous, and based on very limited complete four-cell data. NGAL should not be interpreted as a replacement for FC or as a stand-alone diagnostic test. Larger prospective studies with standardized thresholds, sample types, and reference standards are needed.
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BibTeX
@article{yu2026diagnostic,
title = {{Diagnostic accuracy of Neutrophil Gelatinase-Associated Lipocalin (NGAL) for inflammatory bowel disease: a systematic review and bivariate diagnostic meta-analysis.}},
author = {Ting Yu and Fanyu Meng and Kai Ma and Chen Wang},
journal = {BMC gastroenterology},
year = {2026},
month = sep,
doi = {10.1186/s12876-026-05220-7},
url = {https://europepmc.org/article/MED/42897465},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Diagnostic accuracy of Neutrophil Gelatinase-Associated Lipocalin (NGAL) for inflammatory bowel disease: a systematic review and bivariate diagnostic meta-analysis.
AU - Ting Yu
AU - Fanyu Meng
AU - Kai Ma
AU - Chen Wang
PY - 2026
DA - 2026/09/01
JO - BMC gastroenterology
DO - 10.1186/s12876-026-05220-7
UR - https://europepmc.org/article/MED/42897465
AB - Objective To systematically assess the diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) for inflammatory bowel disease (IBD) and to compare its performance with fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) using marker-specific diagnostic test accuracy meta-analysis.Methods PubMed, Embase, and the Cochrane Library were searched for diagnostic studies using endoscopy and/or histopathology as the reference standard. The primary synthesis used directly reported complete four-cell table data and marker-specific bivariate random-effects models (Reitsma). Exploratory analyses using sensitivity/specificity records were performed only as supplementary checks because patient populations, thresholds, sample types, and reference standards were not sufficiently exchangeable for a formal diagnostic network meta-analysis. Subgroup feasibility, direct-data sensitivity checks, continuity correction use, and Deeks funnel plot asymmetry were assessed.Results Seventy-eight studies with 148 diagnostic records were included. The primary bivariate analysis was based on 27 directly reported complete four-cell records, including 11 FC, 7 CRP, 5 ESR, and 4 NGAL records; 85 sensitivity/specificity records were used only for supplementary exploratory analyses. NGAL showed a pooled sensitivity of 90.9% (95% CI: 66.1%-98.1%) and specificity of 76.1% (95% CI: 42.4%-93.2%), but the estimate was imprecise and underpowered because only 13 NGAL records and 4 complete four-cell records were available. Exploratory network diagnostics did not support clinically interpretable ranking.Conclusion NGAL may have high sensitivity for IBD diagnosis, but current evidence is preliminary, heterogeneous, and based on very limited complete four-cell data. NGAL should not be interpreted as a replacement for FC or as a stand-alone diagnostic test. Larger prospective studies with standardized thresholds, sample types, and reference standards are needed.
SN - 1471-230X
ER -