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首页> 外文期刊>European journal of cardio-thoracic surgery: Official journal of the European Association for Cardio-thoracic Surgery >Diagnostic value of neutrophil gelatinase-associated lipocalin for early diagnosis of cardiac surgery-associated acute kidney injury: a meta-analysis
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Diagnostic value of neutrophil gelatinase-associated lipocalin for early diagnosis of cardiac surgery-associated acute kidney injury: a meta-analysis

机译：中性粒细胞明胶酶相关脂质运载蛋白对心脏手术相关急性肾损伤的早期诊断价值：荟萃分析

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摘要

Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as one of the most sensitive and specific biomarkers for predicting cardiac surgery-associated acute kidney injury (CSA-AKI); however, variable performance characteristics have been reported. We therefore performed a diagnostic meta-analysis to investigate the diagnostic accuracy of NGAL in early (within 12 h postoperatively) diagnosis of CSA-AKI using established guidelines. The search was carried out electronically with Medline (through PubMed interface), Embase, Cochrane library, ISI Web of Science, Scopus and ClinicalTrials.gov (up to 5 September 2014), and hand-searching was also done. Two reviewers conducted study inclusion, data extractions and quality assessment of the studies independently. The diagnostic capacity of NGAL for CSA-AKI was assessed using pooled sensitivity and specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristic curve (AUC). Meta-Disc 1.4 and STATA 12.0 were used to investigate the source of heterogeneity and to perform the meta-analysis. Twenty-four studies (33 data sets of 4066 patients) were considered, which were all of good methodological quality. The overall pooled sensitivity of NGAL for the diagnosis of AKI was 0.68 [95% confidence interval (CI), 0.65-0.70], and specificity was 0.79 (95% CI, 0.77-0.80). The overall pooled positive likelihood ratio and negative likelihood ratio were 3.98 (95% CI, 3.05-5.20) and 0.33 (95% CI, 0.24-0.45), respectively, with a DOR of 13.05 (95% CI, 7.85-21.70). The receiver operating characteristic analysis showed an AUC [standard error (SE)] of 0.86 (0.02) and with a Q*-value (SE) of 0.79 (0.02). Subgroup analysis showed that NGAL had better predictive ability in neonates/children compared with adults (DOR, 19.37; AUC, 0.89 vs DOR, 8.98; AUC, 0.83), and adults without pre-existing renal insufficiency (PRI) had higher diagnostic value than adults without PRI to predict CSA-AKI (DOR, 15.43; AUC, 0.87 vs DOR, 6.56; AUC, 0.81). Both plasma/serum and urine NGAL had the highly predictive nature for early diagnosis of CSA-AKI (DOR, 13.09; AUC, 0.85 vs DOR, 13.20; AUC, 0.88), while lower DOR and AUC values were shown (DOR, 8.31; AUC, 0.81) when measured using standardized clinical platforms, compared with research-based assays (DOR, 19.22; AUC, 0.89). I-2-values showed substantial heterogeneity, which mainly stems from characteristics of patient population (P = 0.037). NGAL diagnostic accuracy in early detection of CSA-AKI is high, especially in neonates/children or adults with normal baseline renal function.
机译：中性粒细胞明胶酶相关的脂蛋白（NGAL）已被确定为预测心脏手术相关的急性肾损伤（CSA-AKI）的最敏感，最特异性的生物标记物之一;然而，已经报道了可变的性能特征。因此，我们进行了诊断性荟萃分析，以使用既定指南调查NGAL在CSA-AKI早期（术后12小时内）诊断中的诊断准确性。搜索是通过Medline（通过PubMed界面），Embase，Cochrane图书馆，ISI Web of Science，Scopus和ClinicalTrials.gov（截至2014年9月5日）以电子方式进行的，并且还进行了手工搜索。两名评论者分别进行了研究纳入，数据提取和研究质量评估。使用合并的敏感性和特异性，诊断比值比（DOR），摘要接收者操作特征曲线下的面积（AUC）评估了NGAL对CSA-AKI的诊断能力。使用Meta-Disc 1.4和STATA 12.0来研究异质性的来源并进行荟萃分析。考虑了24项研究（33个数据集，共4066例患者），所有方法学质量均良好。 NGAL诊断AKI的总敏感性为0.68 [95％置信区间（CI），0.65-0.70]，特异性为0.79（95％CI，0.77-0.80）。总合并的正似然比和负似然比分别为3.98（95％CI，3.05-5.20）和0.33（95％CI，0.24-0.45），DOR为13.05（95％CI，7.85-21.70）。接收机工作特性分析显示，AUC [标准误差（SE）]为0.86（0.02），Q *值（SE）为0.79（0.02）。亚组分析显示，与成人相比，NGAL在新生儿/儿童中具有更好的预测能力（DOR，19.37; AUC，0.89 vs DOR，8.98; AUC，0.83），而没有既往肾功能不全（PRI）的成年人具有更高的诊断价值没有PRI的成年人可以预测CSA-AKI（DOR为15.43; AUC为0.87，而DOR为6.56; AUC为0.81）。血浆/血清和尿液NGAL对CSA-AKI的早期诊断均具有高度预测性（DOR，13.09; AUC，0.85，DOR，13.20; AUC，0.88），但显示出较低的DOR和AUC值（DOR，8.31; DOR，8.34; DOR，8.38）。使用标准化临床平台进行测量时的AUC（0.81），与基于研究的分析相比（DOR，19.22; AUC，0.89）。 I-2-值显示出很大的异质性，这主要源于患者群体的特征（P = 0.037）。早期发现CSA-AKI的NGAL诊断准确性很高，尤其是在基线肾功能正常的新生儿/儿童或成人中。

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