Amaral Pedroso Luana, Nobre Vandack, Dias Carneiro de Almeida Claudmeire, da Silva Praxedes Marcus Fernando, Sernizon Guimarães Nathália, Simões E Silva Ana Cristina, Parreiras Martins Maria Auxiliadora
Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais 31270-901, Brazil.
Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100, Brazil; Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100, Brazil.
Clin Chim Acta. 2020 Sep;508:170-178. doi: 10.1016/j.cca.2020.05.024. Epub 2020 May 12.
Acute kidney injury (AKI) is a highly common complication in intensive care units (ICUs). Novel biomarkers might accelerate the detection and management of AKI. We performed a systematic review aiming to evaluate the performance of biomarkers for early AKI diagnosis in ICUs. MEDLINE, BVS, CINAHL, COCHRANE and EMBASE were searched for studies (2006-2019) on the use of biomarkers for AKI diagnosis. Preselected biomarkers were cystatin C, chitinase-3-like protein-1 (UCHI3L1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1) and interferon-gamma-inducible protein 10 (IP-10/CXCL-10), measured in plasma or urine. Eleven articles with total of 2,289 patients were included. The most cited biomarker was NGAL (n = 7 studies; 63.6%). Biomarkers with the highest sensitivity (se) and specificity (sp) were urinary heat shock protein (HSP-72) (se = 100%; sp = 90%) and urinary IL-18 (se = 92%; sp = 100%). All biomarkers' performance was influenced by the presence of comorbidities or AKI etiology. Although some biomarkers showed good performance, there was no externally validated biomarker for early AKI diagnosis. Thus, from this review, we did not indicate a novel biomarker to be promptly used in clinical practice. Prospective studies with a large number of patients are needed to expand knowledge in this field. PROSPERO registration number CRD42016037325.
急性肾损伤（AKI）是重症监护病房（ICU）中极为常见的并发症。新型生物标志物可能会加速AKI的检测与管理。我们进行了一项系统综述，旨在评估生物标志物在ICU中早期诊断AKI的性能。检索了MEDLINE、BVS、CINAHL、COCHRANE和EMBASE数据库，以查找2006年至2019年期间关于使用生物标志物诊断AKI的研究。预先选定的生物标志物包括胱抑素C、几丁质酶3样蛋白1（UCHI3L1）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白细胞介素18（IL-18）、肾损伤分子1（KIM-1）和干扰素-γ诱导蛋白10（IP-10/CXCL-10），在血浆或尿液中进行检测。纳入了11篇文章，共2289例患者。被引用最多的生物标志物是NGAL（n = 7项研究；63.6%）。敏感性（se）和特异性（sp）最高的生物标志物是尿热休克蛋白（HSP-72）（se = 100%；sp = 90%）和尿IL-18（se = 92%；sp = 100%）。所有生物标志物的性能均受合并症或AKI病因的影响。尽管一些生物标志物表现良好，但尚无经过外部验证的用于早期AKI诊断的生物标志物。因此，从本综述来看，我们并未指明一种可立即用于临床实践的新型生物标志物。需要开展大量患者的前瞻性研究以拓展该领域的知识。PROSPERO注册号CRD42016037325。
