Τίτλος:
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
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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, 0.79-0.81) and 0.86 (95% CI, 0.84-0.86). 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. © 2020 National Kidney Foundation, Inc.
Συγγραφείς:
Albert, C.
Zapf, A.
Haase, M.
Röver, C.
Pickering, J.W.
Albert, A.
Bellomo, R.
Breidthardt, T.
Camou, F.
Chen, Z.
Chocron, S.
Cruz, D.
de Geus, H.R.H.
Devarajan, P.
Di Somma, S.
Doi, K.
Endre, Z.H.
Garcia-Alvarez, M.
Hjortrup, P.B.
Hur, M.
Karaolanis, G.
Kavalci, C.
Kim, H.
Lentini, P.
Liebetrau, C.
Lipcsey, M.
Mårtensson, J.
Müller, C.
Nanas, S.
Nickolas, T.L.
Pipili, C.
Ronco, C.
Rosa-Diez, G.J.
Ralib, A.
Soto, K.
Braun-Dullaeus, R.C.
Heinz, J.
Haase-Fielitz, A.
Περιοδικό:
American Journal of Kidney Diseases
Λέξεις-κλειδιά:
neutrophil gelatinase associated lipocalin; biological marker; neutrophil gelatinase associated lipocalin, acute kidney failure; Article; bivariate analysis; clinical laboratory; clinical practice; data analysis; diagnostic accuracy; diagnostic test; diagnostic test accuracy study; dialysis; disease severity; health care need; high risk patient; human; meta analysis; neutrophil gelatinase associated lipocalin blood level; neutrophil gelatinase associated lipocalin urine level; patient information; prediction; predictive value; protein analysis; protein blood level; protein determination; protein urine level; quantitative study; receiver operating characteristic; reference value; risk assessment; sensitivity and specificity; standardization; statistical model; systematic review; acute kidney failure; blood; hemodialysis; metabolism; predictive value; urine, Acute Kidney Injury; Biomarkers; Humans; Lipocalin-2; Predictive Value of Tests; Renal Dialysis
DOI:
10.1053/j.ajkd.2020.05.015
