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Xu C, Lin S, Mao L, Li Z. Neutrophil gelatinase-associated lipocalin as predictor of acute kidney injury requiring renal replacement therapy: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:859318. [PMID: 36213627 PMCID: PMC9533127 DOI: 10.3389/fmed.2022.859318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusion 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. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346595], identifier [CRD42022346595].
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Affiliation(s)
- Chunhua Xu
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University Health Science Center, School of Biomedical Engineering, Shenzhen, Guangdong, China
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Shan Lin
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
- Department of Central Laboratory, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Longyi Mao
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
| | - Zesong Li
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
- *Correspondence: Zesong Li,
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Borchert E, de la Fuente R, Guzmán AM, González K, Rolle A, Morales K, González R, Jalil R, Lema G. Biomarkers as predictors of renal damage in neonates undergoing cardiac surgery. Perfusion 2020; 36:825-831. [PMID: 33140691 DOI: 10.1177/0267659120968377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery. METHODS Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively. RESULTS nRIFLE criteria were used to divide cohorts in "NO AKI" (12 patients) and "AKI" (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time. CONCLUSIONS The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.
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Affiliation(s)
- Evelyn Borchert
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - René de la Fuente
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Ana María Guzmán
- Clinical Laboratory,Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Katia González
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Augusto Rolle
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Karina Morales
- Pediatric Intensive Care, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Rodrigo González
- Cardiovascular Surgery, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Roberto Jalil
- Nephrology. Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Guillermo Lema
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
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Beitland S, Nakstad ER, Berg JP, Trøseid AMS, Brusletto BS, Brunborg C, Lundqvist C, Sunde K. Urine β-2-Microglobulin, Osteopontin, and Trefoil Factor 3 May Early Predict Acute Kidney Injury and Outcome after Cardiac Arrest. Crit Care Res Pract 2019; 2019:4384796. [PMID: 31205786 PMCID: PMC6530154 DOI: 10.1155/2019/4384796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/09/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Acute kidney injury (AKI) is a common complication after out-of-hospital cardiac arrest (OHCA), leading to increased mortality and challenging prognostication. Our aim was to examine if urine biomarkers could early predict postarrest AKI and patient outcome. METHODS A prospective observational study of resuscitated, comatose OHCA patients admitted to Oslo University Hospital in Norway. Urine samples were collected at admission and day three postarrest and analysed for β-2-microglobulin (β2M), osteopontin, and trefoil factor 3 (TFF3). Outcome variables were AKI within three days according to the Kidney Disease Improving Global Outcome criteria, in addition to six-month mortality and poor neurological outcome (PNO) (cerebral performance category 3-5). RESULTS Among 195 included patients (85% males, mean age 60 years), 88 (45%) developed AKI, 88 (45%) died, and 96 (49%) had PNO. In univariate analyses, increased urine β2M, osteopontin, and TFF3 levels sampled at admission and day three were independent risk factors for AKI, mortality, and PNO. Exceptions were that β2M measured at day three did not predict any of the outcomes, and TFF3 at admission did not predict AKI. In multivariate analyses, combining clinical parameters and biomarker levels, the area under the receiver operating characteristics curves (95% CI) were 0.729 (0.658-0.800), 0.797 (0.733-0.861), and 0.812 (CI 0.750-0.874) for AKI, mortality, and PNO, respectively. CONCLUSIONS Urine levels of β2M, osteopontin, and TFF3 at admission and day three were associated with increased risk for AKI, mortality, and PNO in comatose OHCA patients. This trail is registered with NCT01239420.
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Affiliation(s)
- Sigrid Beitland
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1072 Blindern, 0316 Oslo, Norway
- Department of Anaesthesiology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
| | - Espen Rostrup Nakstad
- Norwegian National Unit for CBRNE Medicine, Oslo University Hospital, P.O.Box 4956 Nydalen, 0424 Oslo, Norway
| | - Jens Petter Berg
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1072 Blindern, 0316 Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
| | - Anne-Marie Siebke Trøseid
- Department of Medical Biochemistry, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
| | - Berit Sletbakk Brusletto
- Department of Medical Biochemistry, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, P.O.Box 1122 Blindern, 0317 Oslo, Norway
| | - Christofer Lundqvist
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1072 Blindern, 0316 Oslo, Norway
- Health Services Research Unit and Department of Neurology, Akershus University Hospital, P.O.Box 1000, 1478 Lørenskog, Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine, University of Oslo, P.O.Box 1072 Blindern, 0316 Oslo, Norway
- Department of Anaesthesiology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
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Klein SJ, Brandtner AK, Lehner GF, Ulmer H, Bagshaw SM, Wiedermann CJ, Joannidis M. Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 2018. [PMID: 29541790 PMCID: PMC5861176 DOI: 10.1007/s00134-018-5126-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose Acute kidney injury (AKI) frequently occurs in critically ill patients and often precipitates use of renal replacement therapy (RRT). However, the ideal circumstances for whether and when to start RRT remain unclear. We performed evidence synthesis of the available literature to evaluate the value of biomarkers to predict receipt of RRT for AKI. Methods We conducted a PRISMA-guided systematic review and meta-analysis including all trials evaluating biomarker performance for prediction of RRT in AKI. A systematic search was applied in MEDLINE, Embase, and CENTRAL databases from inception to September 2017. All studies reporting an area under the curve (AUC) for a biomarker to predict initiation of RRT were included. Results Sixty-three studies comprising 15,928 critically ill patients (median per study 122.5 [31–1439]) met eligibility. Forty-one studies evaluating 13 different biomarkers were included. Of these biomarkers, neutrophil gelatinase-associated lipocalin (NGAL) had the largest body of evidence. The pooled AUCs for urine and blood NGAL were 0.720 (95% CI 0.638–0.803) and 0.755 (0.706–0.803), respectively. Blood creatinine and cystatin C had pooled AUCs of 0.764 (0.732–0.796) and 0.768 (0.729–0.807), respectively. For urine biomarkers, interleukin-18, cystatin C, and the product of tissue inhibitor of metalloproteinase-2 and insulin growth factor binding protein-7 showed pooled AUCs of 0.668 (0.606–0.729), 0.722 (0.575–0.868), and 0.857 (0.789–0.925), respectively. Conclusion Though several biomarkers showed promise and reasonable prediction of RRT use for critically ill patients with AKI, the strength of evidence currently precludes their routine use to guide decision-making on when to initiate RRT. Electronic supplementary material The online version of this article (10.1007/s00134-018-5126-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anna K Brandtner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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