Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis

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...

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Vydáno v:Intensive care medicine Ročník 44; číslo 3; s. 323 - 336
Hlavní autoři: Klein, Sebastian J., Brandtner, Anna K., Lehner, Georg F., Ulmer, Hanno, Bagshaw, Sean M., Wiedermann, Christian J., Joannidis, Michael
Médium: Journal Article
Jazyk:angličtina
Vydáno: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2018
Springer
Springer Nature B.V
Témata:
Acute Kidney Injury - diagnosis
Acute Kidney Injury - therapy
Acute-Phase Proteins
Analysis
Anesthesiology
Biological markers
Biomarkers
Clinical trials
Creatinine
Critical Care Medicine
Cystatin C
Decision making
Emergency Medicine
Evidence-based medicine
Gelatinase
Humans
Injury analysis
Insulin
Intensive
Intensive care
Interleukin 18
Kidney transplantation
Kidneys
Lipocalin
Lipocalin-2
Lipocalins
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Meta-analysis
Metalloproteinase
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Precipitates
Prospective Studies
Protein binding
Proto-Oncogene Proteins
Renal Replacement Therapy
Systematic Review
Therapy
Tissue Inhibitor of Metalloproteinase-2
Urine
Austria
Biomarkers
Renal replacement therapy
Acute kidney injury
Prediction
Meta-analysis
ISSN:0342-4642, 1432-1238, 1432-1238
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Shrnutí: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.
Bibliografie:ObjectType-Article-1
ObjectType-Evidence Based Healthcare-3
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ObjectType-Review-3
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ISSN:0342-4642
1432-1238
1432-1238
DOI:10.1007/s00134-018-5126-8