Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data.
Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data.
复制标题
胱抑素 C 用于检测接受恶性肿瘤化疗的儿童肾功能异常的准确性：使用个体患者数据进行的系统评价。
DOI：
10.1007/s00520-017-4002-3
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Whiting P
中科院分区：
文献类型：
--
作者：
Whiting P
PurposeWe进行了一项系统回顾和个体患者数据（IPD）荟萃分析，以检查cystatin C用于评估儿童cancer.MethodsEligible研究肾小球功能的效用cystatin C用于检测接受化疗的儿童肾功能不佳的准确性。使用QUADAS-2评估研究质量。四项研究的作者分享了IPD。我们计算了按研究和胱抑素C测量分层的log胱抑素C和GFR之间的相关性。我们将GFR 80 ml/min/1.73 m2的参考标准和1 mg/l的分层胱抑素C二分，以计算每项研究和年龄组（0-4岁、5-12岁和≥ 13岁）的灵敏度和特异性。在敏感性分析中，我们研究了不同的GFR和胱抑素C临界点。我们使用逻辑回归估计肾功能受损与日志胱抑素C和定量诊断准确性使用ROC曲线下面积（AUC）.ResultsSix研究，其中使用不同的测试和参考标准的阈值，表明胱抑素C有可能监测肾功能的儿童接受化疗的恶性肿瘤。IPD数据（504份样本，209名儿童）显示，胱抑素C的敏感性较差（63%），特异性中等（89%），尽管使用GFR < 60 ml/min/1.73 m2的临界点（数据仅来自两项研究）估计敏感性为92%，特异性为81.3%。合并数据集的AUC为0.890（95% CI 0.826，0.951）。诊断准确性似乎随着年龄的增长而下降。ConclusionsCystatin C作为年轻人接受癌症治疗时肾小球功能障碍的检测，其诊断准确性优于肌酐。诊断准确性不足以取代目前的参考标准，用于预测可能改变重要肾毒性药物剂量的临床相关损伤。
PurposeWe conducted a systematic review and individual patient data (IPD) meta-analysis to examine the utility of cystatin C for evaluation of glomerular function in children with cancer.MethodsEligible studies evaluated the accuracy of cystatin C for detecting poor renal function in children undergoing chemotherapy. Study quality was assessed using QUADAS-2. Authors of four studies shared IPD. We calculated the correlation between log cystatin C and GFR stratified by study and measure of cystatin C. We dichotomized the reference standard at GFR 80 ml/min/1.73m2and stratified cystatin C at 1 mg/l, to calculate sensitivity and specificity in each study and according to age group (0–4, 5–12, and ≥ 13 years). In sensitivity analyses, we investigated different GFR and cystatin C cut points. We used logistic regression to estimate the association of impaired renal function with log cystatin C and quantified diagnostic accuracy using the area under the ROC curve (AUC).ResultsSix studies, which used different test and reference standard thresholds, suggested that cystatin C has the potential to monitor renal function in children undergoing chemotherapy for malignancy. IPD data (504 samples, 209 children) showed that cystatin C has poor sensitivity (63%) and moderate specificity (89%), although use of a GFR cut point of < 60 ml/min/1.73m2(data only available from two of the studies) estimated sensitivity to be 92% and specificity 81.3%. The AUC for the combined data set was 0.890 (95% CI 0.826, 0.951). Diagnostic accuracy appeared to decrease with age.ConclusionsCystatin C has better diagnostic accuracy than creatinine as a test for glomerular dysfunction in young people undergoing treatment for cancer. Diagnostic accuracy is not sufficient for it to replace current reference standards for predicting clinically relevant impairments that may alter dosing of important nephrotoxic agents.