Ninet Sebastien, Schnell David, Dewitte Antoine, Zeni Fabrice, Meziani Ferhat, Darmon Michael
Réanimation médico-chirurgicale, Hôpital Nord, avenue Albert Raymond, 42270 St Priest en Jarez, France, Université Jean Monnet, Saint-Etienne, France.
Réanimation médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital-BP 426, 67091 Strasbourg Cedex, France.
J Crit Care. 2015 Jun;30(3):629-35. doi: 10.1016/j.jcrc.2015.02.008. Epub 2015 Feb 24.
Doppler-based renal resistive index (RI) might help in distinguishing transient from persistent acute kidney injury (AKI). The main objective of these systematic review and meta-analysis was to investigate the diagnostic performance of RI in predicting short-term reversibility of AKI.
A systematic review of the literature was performed. Relevant studies were identified in Pubmed and Cochrane databases covering the years 1985 to 2013 and reviewed independently by 3 authors. Renal transplant recipients were excluded from this analysis. The summary estimates were computed using a random-effects model based on the DerSimonian and Lair meta-analytic method.
Among the 154 unique articles identified, 9 studies were included. Of the 176 patients in these studies with elevated RI or pulsatility index, 146 (83%) had a persistent AKI vs 44 (16%) of the 273 patients with normal values. Elevated RI or pulsatility index was associated with an increased risk of persistent AKI (odds ratio, 29.85; 95% confidence interval [CI], 8.73-102.16; P < .00001) with significant heterogeneity (I(2) = 75.0%, P < .0001). The pooled sensitivity and specificity were 0.83 (95% CI, 0.77-0.88) and 0.84 (95% CI, 0.79-0.88). The summary positive and negative likelihood ratios were 4.9 (95% CI, 2.44-9.87) and 0.21 (95% CI, 0.11-0.41).
These results suggest that an elevated RI may be a predictor of persistent AKI in critically ill patients. Further studies are warranted, however, to clarify the exact test performance given the marked heterogeneity among the included studies.
基于多普勒的肾阻力指数（RI）可能有助于区分短暂性急性肾损伤（AKI）和持续性急性肾损伤。本系统评价和荟萃分析的主要目的是研究RI在预测急性肾损伤短期可逆性方面的诊断性能。
对文献进行了系统评价。在1985年至2013年的PubMed和Cochrane数据库中识别相关研究，并由3位作者独立进行评审。本分析排除了肾移植受者。使用基于DerSimonian和Laird荟萃分析方法的随机效应模型计算汇总估计值。
在识别出的154篇独特文章中，纳入了9项研究。在这些研究中，176例肾阻力指数或搏动指数升高的患者中，146例（83%）患有持续性急性肾损伤，而273例肾阻力指数或搏动指数正常的患者中，有44例（16%）患有持续性急性肾损伤。肾阻力指数或搏动指数升高与持续性急性肾损伤风险增加相关（优势比，29.85；95%置信区间[CI]，8.73 - 102.16；P <.00001），存在显著异质性（I(2)=75.0%，P <.0001）。汇总敏感性和特异性分别为0.83（95%CI，0.77 - 0.88）和0.84（95%CI，0.79 - 0.88）。汇总阳性和阴性似然比分别为4.9（95%CI，2.44 - 9.87）和0.21（95%CI，0.11 - 0.41）。
这些结果表明，肾阻力指数升高可能是危重症患者持续性急性肾损伤的一个预测指标。然而，鉴于纳入研究之间存在明显异质性，需要进一步研究以明确确切的检测性能。
