Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Clin Exp Nephrol. 2016 Apr;20(2):153-61. doi: 10.1007/s10157-015-1204-1. Epub 2016 Jan 23.
Identifying the potential effective factors of rhabdomyolysis-induced acute kidney injury (AKI) is of major importance for both treatment and logistic concerns. The present study aimed to evaluate the value of creatine kinase (CK) in predicting the risk of rhabdomyolysis-induced AKI through meta-analysis.
Two reviewers searched the electronic databases of Medline, EMBASE, Cochrane library, Scopus, and Google Scholar. Data regarding study design, patient characteristics, number of cases, mean and screening characteristics of CK, and final patient outcome were extracted from relevant studies. Pooled measures of standardized mean difference, OR, and diagnostic accuracy were calculated using STATA version 11.0.
5997 non-redundant studies were found (143 potentially relevant). 27 articles met the inclusion criteria but 9 were excluded due to lack of data. The correlation between serum CK and AKI occurrence was stronger in traumatic cases (SMD = 1.34, 95 % CI = 1.25-1.42, I(2) = 94 %; p < 0.001). This correlation was more prominent in crush-induced AKI (adjusted OR = 14.7, 95 % CI = 7.63-28.52, I(2) = 0.0 %; p = 0.001). Area under the ROC curve of CK in predicting AKI occurrence was 0.75 (95 % CI = 0.71-0.79).
The results of this meta-analysis declared the significant role of rhabdomyolysis etiology (traumatic/non-traumatic) in predictive performance of CK. There was a significant correlation between mean CK level and risk of crush-induced AKI. The pooled OR of CK was considerable, but its screening performance characteristics were not desirable.
确定横纹肌溶解症引起的急性肾损伤（AKI）的潜在有效因素对于治疗和物流考虑都非常重要。本研究旨在通过荟萃分析评估肌酸激酶（CK）在预测横纹肌溶解症引起的 AKI 风险中的价值。
两位审阅者搜索了 Medline、EMBASE、Cochrane 图书馆、Scopus 和 Google Scholar 的电子数据库。从相关研究中提取了研究设计、患者特征、病例数、CK 的平均值和筛查特征以及最终患者结局等数据。使用 STATA 版本 11.0 计算标准化均数差、OR 和诊断准确性的汇总措施。
发现 5997 个非重复研究（143 个潜在相关）。27 篇文章符合纳入标准，但由于缺乏数据，有 9 篇被排除。血清 CK 与 AKI 发生的相关性在创伤性病例中更强（SMD = 1.34，95%CI = 1.25-1.42，I² = 94%；p < 0.001）。这种相关性在挤压诱导的 AKI 中更为明显（调整后的 OR = 14.7，95%CI = 7.63-28.52，I² = 0.0%；p = 0.001）。CK 预测 AKI 发生的 ROC 曲线下面积为 0.75（95%CI = 0.71-0.79）。
这项荟萃分析的结果表明，横纹肌溶解症的病因（创伤性/非创伤性）在 CK 的预测性能中起着重要作用。CK 水平平均值与挤压性 AKI 风险之间存在显著相关性。CK 的汇总 OR 相当可观，但筛查性能特征不理想。
