Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, 15Β, Ag. Thoma str., 115 27, Athens, Greece.
First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Eur J Pediatr. 2018 Oct;177(10):1425-1434. doi: 10.1007/s00431-018-3221-z. Epub 2018 Jul 26.
There is growing evidence that neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of acute kidney injury. The objective of this meta-analysis is to determine the accuracy of serum and urinary NGAL in the detection of acute kidney injury in neonates with perinatal asphyxia. Medline (1966-2018), Scopus (2004-2018), EMBASE (1980-2018), Clinicaltrials.gov (2008-2018), and Google Scholar (2004-2018) databases, along with the reference lists of the electronically retrieved articles, were systematically searched. Eleven studies were included, with a total number of 652 neonates. The summary sensitivity of serum NGAL was 0.818 (95% CI [0.668, 0.909]), the specificity 0.870 (95% CI [0.754, 0.936]), and the area under the curve 0.912. Regarding urinary NGAL, pooled sensitivity was calculated at 0.897 (95% CI [0.829, 0.940]), specificity at 0.729 (95% CI [0.561, 0.850]), and area under the curve at 0.899.
Serum and urinary NGAL represent candidate biomarkers with high performance in the prediction of acute kidney injury in newborns with perinatal asphyxia. Before NGAL can be widely used in clinical practice, future large prospective studies are needed to define the optimal cutoffs and accurately determine which levels are suggestive of post-asphyxial acute kidney injury. What is Known: • Acute kidney injury is a major cause of morbidity and mortality in perinatal asphyxia. • Current markers are insufficient in predicting post-asphyxial acute kidney injury. What is New: • Area under the curve for serum and urinary neutrophil gelatinase-associated lipocalin is 0.818 and 0.899, respectively. • Neutrophil gelatinase-associated lipocalin is a useful marker for detecting asphyxiated neonates at risk of developing acute kidney injury.
本荟萃分析旨在确定血清和尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在诊断围产期窒息新生儿急性肾损伤中的准确性。
我们系统地检索了 Medline（1966 年至 2018 年）、Scopus（2004 年至 2018 年）、EMBASE（1980 年至 2018 年）、Clinicaltrials.gov（2008 年至 2018 年）和 Google Scholar（2004 年至 2018 年）数据库，以及电子检索文章的参考文献列表。
纳入了 11 项研究，共有 652 例新生儿。血清 NGAL 的汇总敏感性为 0.818（95%CI [0.668，0.909]），特异性为 0.870（95%CI [0.754，0.936]），曲线下面积为 0.912。关于尿 NGAL，汇总敏感性为 0.897（95%CI [0.829，0.940]），特异性为 0.729（95%CI [0.561，0.850]），曲线下面积为 0.899。
血清和尿液 NGAL 是围产期窒息新生儿急性肾损伤预测的候选生物标志物，具有较高的性能。在 NGAL 广泛应用于临床实践之前，需要进行未来的大型前瞻性研究来确定最佳截断值，并准确确定哪些水平提示窒息后急性肾损伤。
急性肾损伤是围产期窒息的主要发病和死亡原因。目前的标志物在预测窒息后急性肾损伤方面还不够充分。
血清和尿液中性粒细胞明胶酶相关脂质运载蛋白的曲线下面积分别为 0.818 和 0.899。中性粒细胞明胶酶相关脂质运载蛋白是检测有发生急性肾损伤风险的窒息新生儿的有用标志物。
