Accuracy of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Diagnosis and Prognosis in Acute Kidney Injury: A Systematic Review and Meta-analysis
Accuracy of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Diagnosis and Prognosis in Acute Kidney Injury: A Systematic Review and Meta-analysis
复制标题
DOI：
10.1053/j.ajkd.2009.07.020
复制
发表时间：
2009-12-01
影响因子：
13.2
通讯作者：
Haase-Fielitz, Anja
中科院分区：
文献类型：
--
作者：
Haase, Michael;Bellomo, Rinaldo;Haase-Fielitz, Anja
背景：中性粒细胞明胶酶相关脂钙蛋白（NGAL）似乎是早期诊断急性肾损伤（AKI）的有希望的生物标志物；然而，其预测价值的范围很广。研究设计：使用发给每位作者的定制标准化数据表对诊断试验研究进行meta分析。背景与人群：AKI的不同临床背景。研究选择标准：检索MEDLINE、EMBASE和CENTRAL数据库以及会议摘要，以寻找报道NGAL预测AKI价值的研究。指标测试：损伤后6小时内（如已知）血浆/血清和尿液NGAL，或损伤时间未知的AKI诊断前24-48小时。参考试验：主要结局为AKI，定义为7天内血清肌酐水平较基线升高50%或造影剂肾病（成人肌酐升高25%或浓度> 0.5 mg/dL或儿童在48小时内>升高50%）。使用NGAL预测的其他结果是肾脏替代治疗的开始和住院死亡率。结果：采用层次双变量广义线性模型计算诊断优势比（DOR）和受试者工作特征（AUC-ROC）的样本量加权曲线下面积，我们分析了来自8个国家19项研究的数据，涉及2,538例患者，其中487例（19.2%）发展为AKI。总体而言，NGAL预测AKI的DOR/AUC-ROC为18.6 (95% CI, 9.0-38.1)/0.815 （95% CI, 0.732-0.892）。使用标准化平台时，AKI的DOR/AUC-ROC为25.5 (95% CI, 8.9-72.8)/0.830 (95% CI, 0.741-0.918)，临界值为> 150 ng/mL，而“基于研究的”NGAL测定的DOR/AUC-ROC为16.7 (95% CI, 7.1-39.7)/0.732 （95% CI, 0.656-0.830）。在心脏外科专利中，NGAL的DOR/AUC-ROC为13.1 (95% CI, 5.7-34.8)/0.775 (95% CI, 0.669-0.867)；危重患者为10.0 (95% CI, 3.0-33.1)/0.728 (95% CI, 0.615-0.834)；对比剂输注后为92.0 (95% CI, 10.7 ~ 794.1)/0.894 （95% CI, 0.826 ~ 0.950）。血浆/血清NGAL的诊断准确率（17.9 [95% CI, 6.0-53.7]/0.775 [95% CI, 0.679-0.869]）与尿NGAL的诊断准确率（18.6 [95% CI, 7.2-48.4]/0.837 [95% CI, 0.762-0.906]）相似。我们发现年龄是NGAL值的有效改变因素，与成人（10.6 [95% CI, 4.8-23.4]/0.782 [95% CI, 0.689-0.872]）相比，儿童（25.4 [95% CI, 8.9-72.2]/0.930 [95% CI, 0.883-0.968]）具有更好的预测能力。NGAL水平是预测肾脏替代治疗开始（12.9 [95% CI, 4.9-33.9]/0.782 [95% CI, 0.648-0.917]）和住院死亡率（8.8 [95% CI, 1.9-40.8]/0.706 [95% CI, 0.53 -0.747]）的有效预后工具。局限性：血清肌酐水平用于AKI的定义。结论：NGAL水平对AKI具有诊断和预后价值。[J]肾脏病杂志54:10 - 12。(C) 2009年由国家肾脏基金会，Inc。
Background: Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker for the early diagnosis of acute kidney injury (AKI); however, a wide range in its predictive value has been reported.Study Design: Meta-analysis of diagnostic test studies using custom-made standardized data sheets sent to each author.Setting & Population: Different clinical settings of AKI.Selection Criteria for Studies: MEDLINE, EMBASE, and CENTRAL databases and congress abstracts were searched for studies reporting the value of NGAL to predict AKI.Index Tests: Plasma/serum and urine NGAL within 6 hours from the time of insult (if known) or 24-48 hours before the diagnosis of AKI if the time of insult was not known.Reference Tests: The primary outcome was AKI, defined as an increase in serum creatinine level > 50% from baseline within 7 days or contrast-induced nephropathy (creatinine increase > 25% or concentration > 0.5 mg/dL in adults or > 50% increase in children within 48 hours). Other outcomes predicted using NGAL were renal replacement therapy initiation and in-hospital mortality.Results: Using a hierarchical bivariate generalized linear model to calculate the diagnostic odds ratio (DOR) and sample size-weighted area under the curve for the receiver-operating characterstic (AUC-ROC), we analyzed data from 19 studies and 8 countries involving 2,538 patients, of whom 487 (19.2%) developed AKI. Overall, the DOR/AUC-ROC of NGAL to predict AKI was 18.6 (95% CI, 9.0-38.1)/0.815 (95% CI, 0.732-0.892). The DOR/AUC-ROC when standardized platforms were used was 25.5 (95% CI, 8.9-72.8)/0.830 (95% CI, 0.741-0.918) with a cutoff value > 150 ng/mL for AKI compared with 16.7 (95% CI, 7.1-39.7)/0.732 (95% CI, 0.656-0.830) for "research-based" NGAL assays. In cardiac surgery patents, the DOR/AUC-ROC of NGAL was 13.1 (95% CI, 5.7-34.8)/0.775 (95% CI, 0.669-0.867); in critically ill patients, 10.0 (95% CI, 3.0-33.1)/0.728 (95% CI, 0.615-0.834); and after contrast infusion, 92.0 (95% CI, 10.7-794.1)/0.894 (95% CI, 0.826-0.950). The diagnostic accuracy of plasma/serum NGAL (17.9 [95% CI, 6.0-53.7]/0.775 [95% CI, 0.679-0.869]) was similar to that of urine NGAL (18.6 [95% CI, 7.2-48.4]/0.837 [95% CI, 0.762-0.906]). We identified age to be an effective modifier of NGAL value with better predictive ability in children (25.4 [95% CI, 8.9-72.2]/0.930 [95% CI, 0.883-0.968]) compared with adults (10.6 [95% CI, 4.8-23.4]/0.782 [95% CI, 0.689-0.872]). NGAL level was a useful prognostic tool with regard to the prediction of renal replacement therapy initiation (12.9 [95% CI, 4.9-33.9]/0.782 [95% CI, 0.648-0.917]) and in-hospital mortality (8.8 [95% CI, 1.9-40.8]/0.706 [95% CI, 0.530-0.747]).Limitations: Serum creatinine level was used for AKI definition.Conclusions: NGAL level appears to be of diagnostic and prognostic value for AKI. Am J Kidney Dis 54:1012-1024. (C) 2009 by the National Kidney Foundation, Inc.