尿液、血浆和血清生物标志物在预测成人心脏手术相关急性肾损伤中的应用：一项荟萃分析。

Urinary, Plasma, and Serum Biomarkers' Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis.

机构信息

Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.

Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Seven Oaks Hospital Research Centre, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

出版信息

Am J Kidney Dis. 2015 Dec;66(6):993-1005. doi: 10.1053/j.ajkd.2015.06.018. Epub 2015 Aug 5.

DOI:10.1053/j.ajkd.2015.06.018

PMID:26253993

Abstract

BACKGROUND

Early accurate detection of acute kidney injury (AKI) occurring after cardiac surgery may improve morbidity and mortality. Although several novel biomarkers have been developed for the early detection of AKI, their clinical utility in the critical intraoperative and immediate postoperative period remains unclear.

STUDY DESIGN

Systematic review and meta-analysis.

SETTING & POPULATION: Adult patients having cardiac surgery.

SELECTION CRITERIA FOR STUDIES

EMBASE, CINAHL, Cochrane Library, Scopus, and PubMed from January 1990 until January 2015 were systematically searched for cohort studies reporting the utility of novel biomarkers for the early diagnosis of AKI after adult cardiac surgery. Reviewers extracted data for study design, population, timing of biomarker measurement and AKI occurrence, biomarker performance (area under the receiver operating characteristic curve [AUROC]), and risk of bias.

INDEX TESTS

Novel urine, plasma, and serum AKI biomarkers, measured intraoperatively and in the early postoperative period (<24 hours).

REFERENCE TESTS

AKI was defined according to the RIFLE, AKIN, or 2012 KDIGO criteria.

RESULTS

We found 28 studies reporting intraoperative and/or early postoperative measurement of urine (n=23 studies) or plasma or serum (n=12 studies) biomarkers. Only 4 of these studies measured biomarkers intraoperatively. Overall, intraoperative discrimination by the urine biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury marker 1 (KIM-1) demonstrated AUROCs<0.70, whereas N-acetyl-β-d-glucosaminidase (NAG) and cystatin C had AUROCs<0.75. In the immediate 24-hour postoperative period, the urine biomarkers NGAL (16 studies), KIM-1 (6 studies), and liver-type fatty acid binding protein (6 studies) exhibited composite AUROCs of 0.69 to 0.72. The composite AUROCs for postoperative urine cystatin C, NAG, and interleukin 18 were ≤0.70. Similarly, the composite AUROCs for postoperative plasma NGAL (6 studies) and cystatin-C (5 studies) were <0.70.

LIMITATIONS

Heterogeneous AKI definitions.

CONCLUSIONS

In adults, known urinary, plasma, and serum biomarkers of AKI possess modest discrimination at best when measured within 24 hours of cardiac surgery.

摘要

背景

早期准确检测心脏手术后发生的急性肾损伤（AKI）可能会降低发病率和死亡率。虽然已经开发了几种新型生物标志物用于 AKI 的早期检测，但它们在关键的围手术期和术后即刻的临床实用性仍不清楚。

研究设计

系统评价和荟萃分析。

研究人群

接受心脏手术的成年患者。

研究选择标准

1990 年 1 月至 2015 年 1 月期间，系统地检索了 EMBASE、CINAHL、Cochrane 图书馆、Scopus 和 PubMed 中的队列研究，以报告新型生物标志物在成人心脏手术后早期诊断 AKI 的效用。审查员提取了研究设计、人群、生物标志物测量和 AKI 发生的时间、生物标志物性能（受试者工作特征曲线下面积 [AUROC]）和偏倚风险的数据。

索引测试

新型尿液、血浆和血清 AKI 生物标志物，术中及术后早期（<24 小时）测量。

参考测试

AKI 根据 RIFLE、AKIN 或 2012 KDIGO 标准定义。

结果

我们发现了 28 项报告术中及/或术后早期测量尿液（n=23 项研究）或血浆或血清（n=12 项研究）生物标志物的研究。只有 4 项研究在术中测量了生物标志物。总体而言，尿生物标志物中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肾损伤标志物 1（KIM-1）的术中鉴别能力的 AUROC<0.70，而 N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和胱抑素 C 的 AUROC<0.75。在术后 24 小时内，尿液生物标志物 NGAL（16 项研究）、KIM-1（6 项研究）和肝型脂肪酸结合蛋白（6 项研究）的复合 AUROC 为 0.69 至 0.72。术后尿液胱抑素 C、NAG 和白细胞介素 18 的复合 AUROC≤0.70。同样，术后血浆 NGAL（6 项研究）和胱抑素 C（5 项研究）的复合 AUROC<0.70。