中性粒细胞明胶酶相关脂质运载蛋白在检测失代偿期肝硬化急性肾小管坏死中的可靠性：系统评价与荟萃分析

Reliability of neutrophil gelatinase-associated lipocalin in detecting acute tubular necrosis in decompensated cirrhosis: Systematic review and meta-analysis.

作者信息

Agrawal Nirav, Louis-Jean Scarlet, Ladiwala Zoya, Adnani Harsha, Kamal Ayesha, Karpman Mitchell, Fleisher Albert Steven, Singh Sanmeet

机构信息

Department of Internal Medicine, Anne Arundel Medical Center, Annapolis, MD 21401, United States.

Department of Biostatistics, Anne Arundel Medical Center, Annapolis, MD 21401, United States.

出版信息

World J Hepatol. 2024 Nov 27;16(11):1331-1338. doi: 10.4254/wjh.v16.i11.1331.

DOI:10.4254/wjh.v16.i11.1331

PMID:39606167

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11586751/

Abstract

BACKGROUND

Acute kidney injury (AKI) in cirrhosis is common. The diagnosis of AKI in cirrhosis patients depends on clinical presentation and laboratory tests like serum creatinine. However, urine biomarkers could also be used to assess the type of AKI and the severity of the disease. We performed a systematic review with meta-analysis to evaluate the association with urine neutrophil gelatinase-associated lipocalin (NGAL) marker in identifying acute tubular necrosis (ATN) in patients with cirrhosis.

AIM

To assess the reliability of urine NGAL in the detection of ATN in patients with cirrhosis.

METHODS

We systematically searched MEDLINE and PubMed using keywords including "urine biomarkers", "NGAL", "kidney dysfunction", and "cirrhosis" to identify relevant studies. Data was screened and extracted. Included studies assessed hospitalized cirrhosis patients with AKI using the urine NGAL biomarker. We synthesized the data using diagnostic odds ratio (DOR), comparative and descriptive analyses, and Cochran Mantel-Haenszel (CMH) statistics to evaluate heterogeneity.

RESULTS

Three thousand seven hundred and one patients with cirrhosis were analyzed from a total of 21 cohort studies. The DOR of 14 of those studies [pooled DOR: 22.150, (95%CI: 17.58-27.89), < 0.0001] demonstrated a significant association between urine NGAL levels and its identification of ATN. Following stratification by cirrhosis status, heterogeneity was analyzed and showed a significant non-zero correlation between NGAL and AKI (CMH statistic = 702.19, < 0.0001).

CONCLUSION

In patients with cirrhosis, the use of urine NGAL is a reliable biomarker for detecting ATN and identifying the etiology of AKI.

摘要

背景

肝硬化患者中急性肾损伤（AKI）很常见。肝硬化患者AKI的诊断取决于临床表现和血清肌酐等实验室检查。然而，尿液生物标志物也可用于评估AKI的类型和疾病严重程度。我们进行了一项系统评价和荟萃分析，以评估尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）标志物与肝硬化患者急性肾小管坏死（ATN）识别之间的关联。

目的

评估尿液NGAL在肝硬化患者ATN检测中的可靠性。

方法

我们使用“尿液生物标志物”“NGAL”“肾功能不全”和“肝硬化”等关键词在MEDLINE和PubMed中进行系统检索，以确定相关研究。对数据进行筛选和提取。纳入的研究使用尿液NGAL生物标志物评估住院的肝硬化AKI患者。我们使用诊断比值比（DOR）、比较分析和描述性分析以及 Cochr an Mantel-Haenszel（CMH）统计量来综合数据，以评估异质性。

结果

共纳入21项队列研究，分析了3701例肝硬化患者。其中14项研究的DOR[合并DOR：22.150，（95%CI：17.58 - 27.89），P<0.0001]表明尿液NGAL水平与其对ATN的识别之间存在显著关联。按肝硬化状态分层后，分析异质性，结果显示NGAL与AKI之间存在显著的非零相关性（CMH统计量 = 702.19，P<0.0001）。