Clinical Biochemistry, Black Country Pathology Services, Wolverhampton, West Midlands, UK.
Department of Clinical Biochemistry, New Cross Hospital, Wolverhampton, WV10 0QP, UK.
Sci Rep. 2022 Apr 19;12(1):6436. doi: 10.1038/s41598-022-10477-5.
The objective of this study was to assess the diagnostic value of plasma neutrophil gelatinase-associated lipocalin (pNGAL) for the early diagnosis of acute kidney injury (AKI) in adult patients following cardiac surgery requiring cardiopulmonary bypass (CPB). Electronic databases and other resources were systematically searched for relevant studies. Risk of bias was assessed using the Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Studies were assigned to a sub-group based on the timing of the pNGAL sample in relation to the cessation of CPB. These were < 4 h, 4-8 h, 12 h or 24 h post-cessation of CPB. Summary values for sensitivity and specificity were estimated using the hierarchical summary receiver operator characteristic (ROC) curve model. A random-effects meta-analysis of each pair of sensitivity and specificity estimates from each included study was performed. In total, 3131 patients from 16 studies were included. When taken at 4-8 h following CPB, pNGAL had superior performance for the diagnosis of AKI in the defined population when compared to earlier and later time points. Prediction regions and confidence intervals, however, demonstrated significant variability in pooled estimates of sensitivity and specificity. This is likely due to population and study design heterogeneity, lack of standardisation of assays and thresholds, and inability to distinguish the different molecular forms of NGAL. In conclusion, the diagnostic utility of pNGAL in this clinical setting is inconclusive and large individual studies of representative populations of cardiac surgery patients using assays that specifically detect NGAL in its monomeric form are required.
本研究旨在评估血浆中性粒细胞明胶酶相关脂质运载蛋白（pNGAL）在体外循环（CPB）后成人心脏手术患者急性肾损伤（AKI）早期诊断中的价值。通过电子数据库和其他资源系统地搜索了相关研究。使用诊断准确性研究质量评估工具 2（QUADAS-2）评估了偏倚风险。根据 pNGAL 样本与 CPB 停止时间的关系，将研究分为亚组。这些亚组分别为：CPB 停止后 < 4 小时、4-8 小时、12 小时或 24 小时。使用层次综合接收者操作特征（ROC）曲线模型估计了敏感性和特异性的汇总值。对每个纳入研究的敏感性和特异性估计值对进行了随机效应荟萃分析。总共纳入了来自 16 项研究的 3131 名患者。与更早和更晚的时间点相比，CPB 后 4-8 小时内检测 pNGAL 对 AKI 的诊断具有更好的性能。然而，预测区域和置信区间表明，敏感性和特异性的汇总估计值存在显著的变异性。这可能是由于人群和研究设计的异质性、检测方法和阈值缺乏标准化以及无法区分不同的 NGAL 分子形式所致。总之，在这种临床环境下，pNGAL 的诊断效用尚无定论，需要对代表心脏手术患者的代表性人群进行大型的个体研究，并使用专门检测 NGAL 单体形式的检测方法。
