Neutrophil Gelatinase-Associated Lipocalin Measured on Clinical Laboratory Platforms for the Prediction of Acute Kidney Injury and the Associated Need for Dialysis Therapy: A Systematic Review and Meta-analysis
| Autor: | Zhongquing Chen, Hilde R H de Geus, John W. Pickering, Azrina Ralib, Rinaldo Bellomo, Cemil Kavalci, Fabrice Camou, Peter Buhl Hjortrup, Johan Mårtensson, Mikios Lipcsey, Mercedes Garcia-Alvarez, Claudio Ronco, Christian Röver, Thomas L. Nickolas, Tobias Breidthardt, Rodiger C. Braun-Dullaeus, Georgios Karaolanis, Michael Haase, Karian Soto, Mina Hur, Paola Lentini, Hanah Kim, Christoph Liebetrau, Anja Haase-Fielitz, Judith Heinz, Salvatore Di Somma, Dinna N. Cruz, Guillermo Rosa-Diez, Zoltan H. Endre, Annemarie Albert, Christian Albert, Serafim Nanas, Prasad Devarajan, Chrysoula Pipili, Antonia Zapf, Sidney Chocron, Christian Müller, Kent Doi |
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| Přispěvatelé: | Intensive Care |
| Rok vydání: | 2020 |
| Předmět: |
renal risk assessment
medicine.medical_specialty Kidney Disease AKI prediction urine NGAL medicine.medical_treatment Urinary system Clinical Sciences cut-off value Renal and urogenital 030232 urology & nephrology Cochrane Library Article AKI requiring dialysis 03 medical and health sciences 0302 clinical medicine plasma NGAL Lipocalin-2 Clinical Research Predictive Value of Tests Renal Dialysis Intensive care Internal medicine Humans Medicine 030212 general & internal medicine Renal replacement therapy Dialysis screening and diagnosis business.industry Confounding Acute kidney injury neutrophil gelatinase-associated lipocalin Urology & Nephrology Acute Kidney Injury medicine.disease 3. Good health meta-analysis Detection Good Health and Well Being Nephrology Meta-analysis Public Health and Health Services AKI biomarker diagnostic accuracy business renal replacement therapy Biomarkers 4.2 Evaluation of markers and technologies |
| Zdroj: | AMERICAN JOURNAL OF KIDNEY DISEASES r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname r-IIB SANT PAU: Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Institut dInvestigació Biomèdica Sant Pau (IIB Sant Pau) Am J Kidney Dis American Journal of Kidney Diseases, 76(6), 826-841.e1. W.B. Saunders Università degli Studi di Padova-IRIS American journal of kidney diseases : the official journal of the National Kidney Foundation, vol 76, iss 6 |
| ISSN: | 0272-6386 |
| Popis: | Rationale & Objective: The usefulness of measures of neutrophil gelatinase-associated lipocalin (NGAL) in urine or plasma obtained on clinical laboratory platforms for predicting acute kidney injury (AKI) and AKI requiring dialysis (AKI-D) has not been fully evaluated. We sought to quantitatively summarize published data to evaluate the value of urinary and plasma NGAL for kidney risk prediction. Study Design: Literature-based meta-analysis and individual-study-data meta-analysis of diagnostic studies following PRISMA-IPD guidelines. Setting & Study Populations: Studies of adults investigating AKI, severe AKI, and AKI-D in the setting of cardiac surgery, intensive care, or emergency department care using either urinary or plasma NGAL measured on clinical laboratory platforms. Selection Criteria for Studies: PubMed, Web of Science, Cochrane Library, Scopus, and congress abstracts ever published through February 2020 reporting diagnostic test studies of NGAL measured on clinical laboratory platforms to predict AKI. Data Extraction: Individual-study-data meta analysis was accomplished by giving authors data specifications tailored to their studies and requesting standardized patient-level data analysis. Analytical Approach: Individual-study-data meta analysis used a bivariate time-to-event model for interval-censored data from which discriminative ability (AUC) was characterized. NGAL cutoff concentrations at 95% sensitivity, 95% specificity, and optimal sensitivity and specificity were also estimated. Models incorporated as confounders the clinical setting and use versus nonuse of urine output as a criterion for AKI. A literature-based meta-analysis was also performed for all published studies including those for which the authors were unable to provide individual-study data analyses. Results: We included 52 observational studies involving 13,040 patients. We analyzed 30 data sets for the individual-study-data meta-analysis. For AKI, severe AKI, and AKI-D, numbers of events were 837, 304, and 103 for analyses of urinary NGAL, respectively; these values were 705, 271, and 178 for analyses of plasma NGAL. Discriminative performance was similar in both meta-analyses. Individual-study-data meta-analysis AUCs for urinary NGAL were 0.75 (95% CI, 0.73-0.76) and 0.80 (95% CI, 0.79-0.81) for severe AKI and AKI-D, respectively; for plasma NGAL, the corresponding AUCs were 0.80 (95% CI, 0.790.81) and 0.86 (95% CI, 0.84-0.8 6). Cutoff concentrations at 95% specificity for urinary NGAL were >580 ng/mL with 27% sensitivity for severe AKI and >589 ng/mL with 24% sensitivity for AKI-D. Corresponding cutoffs for plasma NGAL were >364 ng/mL with 44% sensitivity and >546 ng/mL with 26% sensitivity, respectively. Limitations: Practice variability in initiation of dialysis. Imperfect harmonization of data across studies. Conclusions: Urinary and plasma NGAL concentrations may identify patients at high risk for AKI in clinical research and practice. The cutoff concentrations reported in this study require prospective evaluation. |
| Databáze: | OpenAIRE |
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