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
Por:
Albert, C, Zapf, A, Haase, M, Rover, C, Pickering, JW, Albert, A, Bellomo, R, Breidthardt, T, Camou, F, Chen, ZQ, Chocron, S, Cruz, D, de Geus, HRH, Devarajan, P, Di Somma, S, Doi, K, Endre, ZH, Garcia-Alvarez, M, Hjortrup, PB, Hur, M, Karaolanis, G, Kavalci, C, Kim, H, Lentini, P, Liebetrau, C, Lipcsey, M, Martensson, J, Muller, C, Nanas, S, Nickolas, TL, Pipili, C, Ronco, C, Rosa-Diez, GJ, Ralib, A, Soto, K, Braun-Dullaeus, RC, Heinz, J, Haase-Fielitz, A
Publicada:
1 dic 2020
Resumen:
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.
Filiaciones:
Albert, C:
Otto von Guericke Univ, Univ Clin Cardiol & Angiol, Med Fac, Magdeburg, Germany
Diaverum Renal Serv Germany, MVZ Neuen Garten 11, D-14469 Potsdam, Germany
Zapf, A:
Univ Med Ctr Hamburg Eppendorf, Dept Med Biometry & Epidemiol, Hamburg, Germany
Haase, M:
Otto von Guericke Univ, Fac Med, Magdeburg, Germany
Diaverum Renal Serv Germany, MVZ Neuen Garten 11, D-14469 Potsdam, Germany
Rover, C:
Univ Med Ctr Gottingen, Dept Med Stat, Gottingen, Germany
Pickering, JW:
Univ Otago Christchurch, Dept Med, Christchurch, New Zealand
Christchurch Hosp, Emergency Dept, Christchurch, New Zealand
Albert, A:
Diaverum Renal Serv Germany, MVZ Neuen Garten 11, D-14469 Potsdam, Germany
Klinikum Ernst von Bergmann, Dept Nephrol & Endocrinol, Potsdam, Germany
Bellomo, R:
Austin Hosp, Dept Intens Care, Melbourne, Vic, Australia
Univ Melbourne, Ctr Integrated Crit Care, Melbourne, Vic, Australia
Breidthardt, T:
Univ Hosp Basel, Dept Internal Med, Basel, Switzerland
Univ Hosp Basel, Dept Nephrol, Basel, Switzerland
Univ Hosp Basel, Dept Cardiol, Basel, Switzerland
Camou, F:
CHU Bordeaux, Hop St Andre, Serv Reanimat Med, Bordeaux, France
Chen, ZQ:
Southern Med Univ, Nanfang Hosp, Dept Crit Care Med, Guangzhou, Guangdong, Peoples R China
Chocron, S:
Univ Hosp Jean Minjoz, Dept Thorac & Cardiovasc Surg, Besancon, France
Cruz, D:
Univ Calif San Diego, Div Nephrol Hypertens, San Diego, CA 92103 USA
de Geus, HRH:
Erasmus MC, Dept Intens Care, Rotterdam, Netherlands
Devarajan, P:
Univ Cincinnati, Div Nephrol & Hypertens, Cincinnati Childrens Hosp, Cincinnati, OH USA
Di Somma, S:
Univ Rome, Dept Med Surg Sci & Translat Med, Emergency Med, S Andrea Hosp, Rome, Italy
Doi, K:
Univ Tokyo, Dept Emergency & Crit Care Med, Tokyo, Japan
Endre, ZH:
Univ New South Wales, Prince Wales Hosp, Dept Nephrol, Sydney, NSW, Australia
Univ New South Wales, Clin Sch, Dept Nephrol, Sydney, NSW, Australia
Garcia-Alvarez, M:
Hosp Santa Creu Sant & Pau, Dept Anesthesiol, Barcelona, Spain
Hjortrup, PB:
Copenhagen Univ Hosp, Dept Intens Care, Copenhagen, Denmark
Hur, M:
Konkuk Univ, Dept Lab Med, Sch Med, Seoul, South Korea
Karaolanis, G:
Natl & Kapodistrian Univ Athens, Med Sch, Laiko Gen Hosp, Vasc Unit,Dept Surg 1, Athens, Greece
Kavalci, C:
Baskent Univ, Emergency Dept, Fac Med, Ankara, Turkey
Kim, H:
Konkuk Univ, Dept Lab Med, Sch Med, Seoul, South Korea
Lentini, P:
San Bassiano Hosp, Dept Nephrol & Dialysis, Bassano Del Grappa, Italy
Liebetrau, C:
Kerckhoff Clin, Dept Cardiol, Bad Nauheim, Germany
Lipcsey, M:
Uppsala Univ, Dept Surg Sci, CIRRUS, Anaesthesiol & Intens Care,Hedenstierna Lab, Uppsala, Sweden
Martensson, J:
Karolinska Inst, Sect Anaesthesia & Intens Care Med, Dept Physiol & Pharmacol, Stockholm, Sweden
Muller, C:
Univ Hosp Basel, Dept Internal Med, Basel, Switzerland
Univ Hosp Basel, Dept Nephrol, Basel, Switzerland
Univ Hosp Basel, Dept Cardiol, Basel, Switzerland
Nanas, S:
Natl & Kapodistrian Univ Athens, Evangelismos Gen Hosp, Crit Care Dept 1, Athens, Greece
Nickolas, TL:
Columbia Univ, Vagelos Coll Phys & Surg, New York, NY USA
Pipili, C:
Natl & Kapodistrian Univ Athens, Evangelismos Gen Hosp, Crit Care Dept 1, Athens, Greece
Ronco, C:
Univ Padua, Nephrol Dialysis & Transplantat, Padua, Italy
San Bortolo Hosp, Int Renal Res Inst, Vicenza, Italy
Rosa-Diez, GJ:
Hosp Italiano Buenos Aires, Dept Nephrol Dialysis & Transplantat, Buenos Aires, DF, Argentina
Ralib, A:
Int Islamic Univ Malaysia, Dept Anaesthesiol & Intens Care, Pahang, Malaysia
Soto, K:
Hosp Fernando Fonseca, Dept Nephrol, Amadora, Portugal
Univ Lisbon, Ctr Estat & Aplicacoes, CEAUL, Lisbon, Portugal
Braun-Dullaeus, RC:
Otto von Guericke Univ, Univ Clin Cardiol & Angiol, Med Fac, Magdeburg, Germany
Heinz, J:
Univ Med Ctr Gottingen, Dept Med Stat, Gottingen, Germany
Haase-Fielitz, A:
Univ Potsdam, Brandenburg Med Sch Theodor Fontane, Immanuel Diakonie Bernau, Heart Ctr Brandenburg,Dept Cardiol,Fac Hlth Sci, Potsdam, Germany
Green Accepted
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