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Biomedical Science Doctorate Studies Decision Tree Algorithms and Urine Biomarkers for Early Detection of Acute Kidney Failure in Critically ICU Patients
Biomedical Science Doctorate Studies Decision Tree Algorithms and Urine Biomarkers for Early Detection of Acute Kidney Failure in Critically ICU Patients
Held in the Meeting Room on the 3rd Floor of the Postgraduate Building, Udayana University, on Jl. PB Sudirman, Denpasar, Bali, the Biomedical Science Doctoral Study Program, Faculty of Medicine, Udayana University, held an open doctoral promotion examination with Dr. Marilaeta Cindryani Ra Ratumasa, M.Biomed., SpAn-Ti., Subsp.TI (K)., with the dissertation title "Decision Tree Algorithm Compared with Renal Resistive Index in Determining Acute Kidney Failure Criteria Using Galectin-3 and Neutrophil Gelatinase-Associated Lipocalin (NGAL) Urine Biomarkers in Critically Ill Patients in the Intensive Care Unit of Prof. Igng Ngoerah General Hospital." (May 18, 2026)
Acute Kidney Injury (AKI) is a major comorbidity in the Intensive Care Unit (ICU), increasing the risk of morbidity and mortality. The diagnosis of AKI is often hampered by a delay in the increase in serum creatinine, necessitating a more responsive method from the subclinical stage. This study aimed to evaluate the ability of the Decision Tree Algorithm (DTA) to determine AKI criteria compared to the Renal Resistive Index (RRI) and the use of Galectin-3 and Neutrophil Gelatinase-Associated Lipocalin (NGAL) urinary biomarkers in critically ill patients.
This prospective observational study was conducted in the ICU of Prof. IGNG Ngoerah General Hospital, involving 78 patient samples. The study methods included clinical data collection for the DTA dataset, RRI examination using Doppler ultrasonography, and measurement of Galectin-3 and NGAL urinary levels using the ELISA method. The study process involved sensitivity, specificity, accuracy, and Area Under the Curve (AUC) analysis. Multivariate analysis was also performed to determine the predictive power of both methods in critically ill patients.
The results showed that the DTA had moderate validity (AUC 0.55–0.60; sensitivity 72.73%; accuracy 48.72%), which was superior to the RRI, which had low validity (AUC 0.39–0.41; sensitivity 36.36%). Although not statistically significant as an independent predictor (p=0.078), the DTA demonstrated higher predictive ability than the RRI (p=0.154). The biomarker criteria were proven to be able to identify AKI earlier in the subclinical phase, before changes in renal hemodynamics occur.
This study found that the Decision Tree Algorithm had better validity and predictive power than the Renal Resistive Index in determining the incidence of AKI in critically ill patients in the ICU.
The examination was led by the Coordinator of the Doctoral Program in Biomedical Sciences, Faculty of Medicine, Udayana University, Prof. Dr. dr. Desak Made Wihandani, M.Kes., with the following examiners:
1. Prof. Dr. dr. Ketut Suryana, Sp.PDKAI., FINASIM (Promoter)
2. Prof. Dr.dr.Tjok Gde Agung Senapathi, Sp.An-TI., Subsp.An.R(K) (Copromotor I)
3.Dr. Dr. Gede Wirya Kusuma Duarsa, Sp.U., Subsp.Ped., M.Kes., MARS (Copromotor II)
4. Prof. Dr. Dr. I Made Jawi, M. Kes
5. Prof. Dr. Dr. Tjokorda Gde Bagus Mahadewa, M.Kes., Sp.BS(K) Spinal,FICS,FINSS
6. Prof. Dr. Dr. Komang Januartha Putra Pinatih, M.Kes
7. Prof. Dr. Dr. Urged Made Wihandani, M.Kes
8.Dr. Dr. I Made Gede Widnyana, M.Kes., Sp.An-TI., Subsp.An.R(K)
9.Dr. Dr. I Gusti Ngurah Mahaalit Aribawa, Sp.AnTI., Subsp.An.R.(K),FIP
10.Dr. Dr. I Made Mulyawan, Sp.B., Subsp.BD (K)
By academic invitation:
1.Dr. Dr. Ari Andayani, Sp.M(K)., MH.Kes
2.Dr. Pande Made Wisnu Tirtayasa, Sp.U(K)., Ph.D
3.Dr. Dr. Putu Agus Surya Panji, Sp.An-TI., Subsp.T.I.(K)
4.Dr. Dr. I Gusti Agung Gede Utara Hartawan, Sp.An-TI., MARS., SH
5.Dr. Dr. Kade Yudi Saspriyana, M.Biomed., Sp.O.G., Subsp.Onk
During this exam, Dr. dr. Marilaeta Cindryani Ra Ratumasa, M.Biomed., SpAn-Ti., Subsp.TI (K)., was declared the 494th Doctoral Graduate of the Biomedical Sciences Doctoral Program, Faculty of Medicine, Udayana University, with Cum Laude honors.
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