This systematic review analyzed 35 studies to assess the performance of three key Acute Kidney Injury (AKI) biomarkers—NGAL, KIM-1, and TIMP-2 ⋅ IGFBP7—in the Intensive Care Unit (ICU) setting.

NGAL (Neutrophil Gelatinase-Associated Lipocalin): Showed the strongest and most consistent early predictive value for AKI, especially in medical and septic ICU patients.

TIMP-2 – IGFBP7: Demonstrated promise as an effective early stress marker, particularly valuable in septic patients.

KIM-1 (Kidney Injury Molecule-1): Appeared more useful for detecting sustained tubular injury but had generally moderate overall performance.

The review concludes that while NGAL and TIMP-2 ⋅ IGFBP7 show the most consistent performance for early AKI detection, no single biomarker is sufficient for routine use.

The future of AKI prognostics likely lies in combined approaches to enhance accuracy.

Further research is needed to confirm the clinical utility, evaluate cost-effectiveness, and integrate these tools into standardized, patient-centered diagnostic workflows.

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