Patients with severe acute kidney injury (AKI) may require renal replacement therapy (RRT), such as hemodialysis and peritoneal dialysis. Neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive indicator for early diagnosis and recognition of AKI; however, its predictive value of AKI-associated need for RRT needs further evaluation.Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, relevant articles were systematically searched and selected from seven databases. The random effects model was applied to evaluate the predictive performance of NGAL for AKI requiring RRT. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of each included study.A total of 18 studies including 1,787 patients with AKI and having an average NOS score of 7.67 were included in the meta-analysis. For plasma/serum NGAL, the pooled sensitivity and specificity with corresponding 95% confidence interval (CI) were 0.75 (95% CI: 0.68-0.81) and 0.76 (95% CI: 0.70-0.81), respectively. The pooled positive likelihood ratio (PLR) was 2.9 (95% CI: 2.1-4.1), and the pooled negative likelihood ratio (NLR) was 0.34 (95% CI: 0.25-0.46). Subsequently, the pooled diagnostic odds ratio (DOR) was 9 (95% CI: 5-16) using a random effects model, and the area under the curve (AUC) of summary receiver operating characteristic to summarize predictive accuracy was 0.82 (95% CI: 0.79-0.85). For urine NGAL, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC values were 0.78 (95% CI: 0.61-0.90), 0.77 (95% CI: 0.65-0.85), 3.4 (95% CI: 2.4-4.8), 0.28 (95% CI: 0.15-0.52), 12 (95% CI: 6-24), and 0.84 (95% CI: 0.80-0.87), respectively.Plasma/serum and urine NGAL levels performed comparably well in predicting AKI requiring RRT. Our findings suggested that NGAL is an effective predictive biomarker for the AKI-associated need for RRT. Nevertheless, more pieces of high-quality evidence and future trials with larger sample sizes are needed for further improvement of patient outcomes.[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346595], identifier [CRD42022346595].Copyright © 2022 Xu, Lin, Mao and Li.