Xu Qing, Zhou Zhifeng, Jin Lu, Liu Chen, Li Peiyun, Wang Fang, Zhang Ling, Fu Ping
Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
Crit Care. 2025 May 26;29(1):213. doi: 10.1186/s13054-025-05451-2.
Renal replacement therapy (RRT) is commonly used in critically ill patients with acute kidney injury (AKI). However, optimal timing of RRT liberation remains controversy. This meta-analysis evaluates novel biomarkers to predict successful RRT liberation in critically ill AKI patients.
The systematic review reported following PRISMA guidelines, PubMed, Embase, and Scopus were searched up to May 2, 2025, and were screened using predefined criteria. Methodological quality was assessed using the Newcastle-Ottawa scale. Pooled ROC-AUCs with 95% CIs were calculated; heterogeneity was evaluated using I statistics.
Sixteen studies (3020 patients) involving 23 biomarkers were included. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) demonstrated fair predictive performance with 4 studies (AUC 0.766, I = 39.8%). When excluding a study focused on long-term outcomes, the result showed a better predictive ability with low heterogeneity (AUC 0.801, I = 0%). Plasma proenkephalin A (PENK) and serum NGAL also showed potential, but quantitative synthesis was limited by study number and heterogeneity. The cut-off value also varied widely, complicating clinical translation. In addition, multivariable models combining novel biomarkers with clinical indicators have also demonstrated promising predictive potential. However, due to the limited number of studies and inconsistent conclusions, further exploration is needed.
uNGAL moderately predicts short-term RRT liberation, while other biomarkers (e.g., PENK) require further validation. Standardizing definitions of successful liberation and integrating dynamic biomarker changed with clinical indicators (e.g., urine output) may enhance predictive accuracy. Further large-scale, prospective, and multicenter studies are needed to validate these findings.
肾脏替代治疗（RRT）常用于急性肾损伤（AKI）的危重症患者。然而，RRT撤机的最佳时机仍存在争议。本荟萃分析评估了新型生物标志物，以预测危重症AKI患者RRT撤机成功情况。
按照PRISMA指南进行系统评价，检索截至2025年5月2日的PubMed、Embase和Scopus数据库，并使用预定义标准进行筛选。采用纽卡斯尔-渥太华量表评估方法学质量。计算合并的ROC-AUC及95%置信区间；使用I统计量评估异质性。
纳入了16项研究（3020例患者），涉及23种生物标志物。尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）在4项研究中显示出较好的预测性能（AUC 0.766，I=39.8%）。排除一项关注长期结局的研究后，结果显示预测能力更佳且异质性较低（AUC 0.801，I=0%）。血浆前脑啡肽A（PENK）和血清NGAL也显示出潜力，但定量合成受研究数量和异质性限制。截断值也差异很大，使临床转化复杂化。此外，将新型生物标志物与临床指标相结合的多变量模型也显示出有前景的预测潜力。然而，由于研究数量有限且结论不一致，需要进一步探索。
uNGAL对短期RRT撤机有中度预测作用，而其他生物标志物（如PENK）需要进一步验证。标准化撤机成功的定义并将动态生物标志物变化与临床指标（如尿量）相结合，可能会提高预测准确性。需要进一步开展大规模、前瞻性和多中心研究来验证这些发现。
