Urinary Interleukin 18 for Detection of Acute Kidney Injury: A Meta-analysis
Urinary Interleukin 18 for Detection of Acute Kidney Injury: A Meta-analysis
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尿白细胞介素 18 用于检测急性肾损伤：荟萃分析
DOI：
10.1053/j.ajkd.2013.05.014
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发表时间：
2013-12-01
影响因子：
13.2
通讯作者：
Dai, Bing
中科院分区：
文献类型：
--
作者：
Liu, Yawei;Guo, Wenyuan;Dai, Bing
背景：白细胞介素 18 (IL-18) 已被提议作为急性肾损伤 (AKI) 早期检测的生物标志物，但其预测准确性的范围广泛。研究设计：诊断测试研究的荟萃分析。背景和人群：AKI 的各种临床环境，包括心脏手术后、造影剂输注后、急诊室或重症监护病房。研究选择标准：调查 IL-18 诊断准确性的前瞻性研究指数测试：增加或增加尿 IL-18 排泄。参考测试：主要结果是 AKI 的发展，主要基于血清肌酐水平（不同研究的定义各不相同）。另一个结局是院内死亡率。结果：我们分析了 7 个国家的 23 项研究的数据，涉及 4,512 名患者。在这些研究中，有 18 项可以纳入荟萃分析。在所有设置中，尿 IL-18 水平预测 AKI 的诊断比值比 (DOR) 为 4.22（95% CI，2.90-6.14），敏感性和特异性分别为 0.58 和 0.75。尿液 IL-18 水平预测 AKI 的受试者工作特征曲线下面积 (AUROC) 为 0.70 (95% CI, 0.66-0.74)。亚组分析显示，心脏手术患者尿 IL-18 的 DOR/AUROC 为 5.32 (95% CI, 2.92-9.70)/0.72 (95% CI, 0.68-0.76)，重症监护病房或冠心病患者尿 IL-18 的 DOR/AUROC 为 3.65 (95% CI, 1.88-7.10)/0.66 (95% CI, 0.62-0.70)护理单位的病人。按年龄分层后，IL-18 水平在儿童和青少年中的诊断准确性优于成人：8.12 (95% CI, 3.79-17.41)/0.78 (95% CI, 0.75-0.82) 对比 3.31 (95% CI, 2.28-4.80)/0.66 (95% CI, 0.62-0.70)。不同时期尿IL-18水平的预测性能无显着差异。 AKI 的定义不同，血清肌酐水平作为 AKI 诊断的参考标准测试。结论：尿液 IL-18 是 AKI 的有用生物标志物，在所有临床环境中具有中等预测价值。 (C) 2013 年，国家肾脏基金会 (National Kidney Foundation, Inc.)
Background: Interleukin 18 (IL-18) has been proposed as a biomarker for the early detection of acute kidney injury (AKI), but a broad range of its predictive accuracy has been reported.Study Design: Meta-analysis of diagnostic test studies.Setting & Population: Various clinical settings of AKI, including after cardiac surgery, after contrast infusion, in the emergency department, or in the intensive care unit.Selection Criteria for Studies: Prospective studies that investigated the diagnostic accuracy of IL-18 level to predict AKI.Index Tests: Increasing or increased urinary IL-18 excretion.Reference Tests: The primary outcome was AKI development, mainly based on serum creatinine level (definition varied across studies). The other outcome was in-hospital mortality.Results: We analyzed data from 23 studies and 7 countries involving 4,512 patients. Of these studies, 18 could be included in the meta-analysis. Across all settings, the diagnostic odds ratio (DOR) for urinary IL-18 level to predict AKI was 4.22 (95% CI, 2.90-6.14), with sensitivity and specificity of 0.58 and 0.75, respectively. The area under the receiver operating characteristic curve (AUROC) of urinary IL-18 level to predict AKI was 0.70 (95% CI, 0.66-0.74). Subgroup analysis showed the DOR/AUROC of urinary IL-18 was 5.32 (95% CI, 2.92-9.70)/0.72 (95% CI, 0.68-0.76) in cardiac surgery patients and 3.65 (95% CI, 1.88-7.10)/0.66 (95% CI, 0.62-0.70) in intensive care unit or coronary care unit patients. After stratification for age, IL-18 level had better diagnostic accuracy in children and adolescents versus adults: 8.12 (95% CI, 3.79-17.41)/0.78 (95% CI, 0.75-0.82) versus 3.31 (95% CI, 2.28-4.80)/0.66 (95% CI, 0.62-0.70). There was no significant difference in predictive performance of urinary IL-18 level among various times.Limitations: Various clinical settings; different definition of AKI and serum creatinine level as the reference standard test for the diagnosis of AKI.Conclusions: Urinary IL-18 is a useful biomarker of AKI with moderate predictive value across all clinical settings. (C) 2013 by the National Kidney Foundation, Inc.