中性粒细胞明胶酶相关脂质运载蛋白作为需要肾脏替代治疗的急性肾损伤的预测指标：一项系统评价和荟萃分析。
Neutrophil gelatinase-associated lipocalin as predictor of acute kidney injury requiring renal replacement therapy: A systematic review and meta-analysis.
作者信息
Xu Chunhua, Lin Shan, Mao Longyi, Li Zesong
机构信息
Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China.
Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University Health Science Center, School of Biomedical Engineering, Shenzhen, Guangdong, China.
出版信息
Front Med (Lausanne). 2022 Sep 21;9:859318. doi: 10.3389/fmed.2022.859318. eCollection 2022.
BACKGROUND
Patients with severe acute kidney injury (AKI) may require renal replacement therapy (RRT), such as hemodialysis and peritoneal dialysis. Neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive indicator for early diagnosis and recognition of AKI; however, its predictive value of AKI-associated need for RRT needs further evaluation.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, relevant articles were systematically searched and selected from seven databases. The random effects model was applied to evaluate the predictive performance of NGAL for AKI requiring RRT. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of each included study.
RESULTS
A total of 18 studies including 1,787 patients with AKI and having an average NOS score of 7.67 were included in the meta-analysis. For plasma/serum NGAL, the pooled sensitivity and specificity with corresponding 95% confidence interval (CI) were 0.75 (95% CI: 0.68-0.81) and 0.76 (95% CI: 0.70-0.81), respectively. The pooled positive likelihood ratio (PLR) was 2.9 (95% CI: 2.1-4.1), and the pooled negative likelihood ratio (NLR) was 0.34 (95% CI: 0.25-0.46). Subsequently, the pooled diagnostic odds ratio (DOR) was 9 (95% CI: 5-16) using a random effects model, and the area under the curve (AUC) of summary receiver operating characteristic to summarize predictive accuracy was 0.82 (95% CI: 0.79-0.85). For urine NGAL, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC values were 0.78 (95% CI: 0.61-0.90), 0.77 (95% CI: 0.65-0.85), 3.4 (95% CI: 2.4-4.8), 0.28 (95% CI: 0.15-0.52), 12 (95% CI: 6-24), and 0.84 (95% CI: 0.80-0.87), respectively.
CONCLUSION
Plasma/serum and urine NGAL levels performed comparably well in predicting AKI requiring RRT. Our findings suggested that NGAL is an effective predictive biomarker for the AKI-associated need for RRT. Nevertheless, more pieces of high-quality evidence and future trials with larger sample sizes are needed for further improvement of patient outcomes.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346595], identifier [CRD42022346595].
背景
重症急性肾损伤（AKI）患者可能需要肾脏替代治疗（RRT），如血液透析和腹膜透析。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是早期诊断和识别AKI的敏感指标；然而，其对AKI相关RRT需求的预测价值需要进一步评估。
方法
按照系统评价和Meta分析的首选报告项目指南，从七个数据库中系统检索和筛选相关文章。应用随机效应模型评估NGAL对需要RRT的AKI的预测性能。采用纽卡斯尔-渥太华量表（NOS）评估每项纳入研究的质量。
结果
荟萃分析共纳入18项研究，涉及1787例AKI患者，平均NOS评分为7.67。对于血浆/血清NGAL，合并敏感度及相应95%置信区间（CI）为0.75（95%CI：0.68-0.81），合并特异度及相应95%CI为0.76（95%CI：0.70-0.81）。合并阳性似然比（PLR）为2.9（95%CI：2.1-4.1），合并阴性似然比（NLR）为0.34（95%CI：0.25-0.46）。随后，采用随机效应模型得到的合并诊断比值比（DOR）为9（95%CI：5-16），汇总受试者工作特征曲线下面积（AUC）以总结预测准确性，为0.82（95%CI：0.79-0.85）。对于尿NGAL，合并敏感度、特异度、PLR、NLR、DOR和AUC值分别为0.78（95%CI：0.61-0.90）、0.77（95%CI：0.65-0.85）、3.4（95%CI：2.4-4.8）、0.28（95%CI：0.15-0.52）、12（95%CI：6-24）和0.84（95%CI：0.80-0.87）。
结论
血浆/血清和尿NGAL水平在预测需要RRT的AKI方面表现相当。我们的研究结果表明，NGAL是AKI相关RRT需求的有效预测生物标志物。然而，需要更多高质量证据和更大样本量的未来试验来进一步改善患者预后。
系统评价注册
[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346595]，标识符[CRD42022346595]。
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