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Abstract：
BACKGROUND: Although the present diagnosis of acute kidney injury (AKI) involves measurement of acute increases in serum creatinine (SC) and reduced urine output (UO), measurement of UO is underutilized for diagnosis of AKI in clinical practice. The purpose of this investigation was to conduct a systematic literature review of published studies that evaluate both UO and SC in the detection of AKI to better understand incidence, healthcare resource use, and mortality in relation to these diagnostic measures and how these outcomes may vary by population subtype.
METHODS: The systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data were extracted from comparative studies focused on the diagnostic accuracy of UO and SC, relevant clinical outcomes, and resource usage. Quality and validity were assessed using the National Institute for Health and Care Excellence (NICE) single technology appraisal quality checklist for randomized controlled trials and the Newcastle-Ottawa Quality Assessment Scale for observational studies.
RESULTS: A total of 1729 publications were screened, with 50 studies eligible for inclusion. A majority of studies (76%) used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to classify AKI and focused on the comparison of UO alone versus SC alone, while few studies analyzed a diagnosis of AKI based on the presence of both UO and SC, or the presence of at least one of UO or SC indicators. Of the included studies, 33% analyzed patients treated for cardiovascular diseases and 30% analyzed patients treated in a general intensive care unit. The use of UO criteria was more often associated with increased incidence of AKI (36%), than was the application of SC criteria (21%), which was consistent across the subgroup analyses performed. Furthermore, the use of UO criteria was associated with an earlier diagnosis of AKI (2.4-46.0 h). Both diagnostic modalities accurately predicted risk of AKI-related mortality.
CONCLUSIONS: Evidence suggests that the inclusion of UO criteria provides substantial diagnostic and prognostic value to the detection of AKI.
METHODS: The systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data were extracted from comparative studies focused on the diagnostic accuracy of UO and SC, relevant clinical outcomes, and resource usage. Quality and validity were assessed using the National Institute for Health and Care Excellence (NICE) single technology appraisal quality checklist for randomized controlled trials and the Newcastle-Ottawa Quality Assessment Scale for observational studies.
RESULTS: A total of 1729 publications were screened, with 50 studies eligible for inclusion. A majority of studies (76%) used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to classify AKI and focused on the comparison of UO alone versus SC alone, while few studies analyzed a diagnosis of AKI based on the presence of both UO and SC, or the presence of at least one of UO or SC indicators. Of the included studies, 33% analyzed patients treated for cardiovascular diseases and 30% analyzed patients treated in a general intensive care unit. The use of UO criteria was more often associated with increased incidence of AKI (36%), than was the application of SC criteria (21%), which was consistent across the subgroup analyses performed. Furthermore, the use of UO criteria was associated with an earlier diagnosis of AKI (2.4-46.0 h). Both diagnostic modalities accurately predicted risk of AKI-related mortality.
CONCLUSIONS: Evidence suggests that the inclusion of UO criteria provides substantial diagnostic and prognostic value to the detection of AKI.
摘要：
背景：尽管目前对急性肾损伤（AKI）的诊断涉及血清肌酐（SC）和尿量减少（UO）的急性增加，在临床实践中，UO的测量未被用于AKI的诊断。这项调查的目的是对已发表的研究进行系统的文献综述，这些研究评估了UO和SC在AKI检测中的作用，以更好地了解发病率。医疗保健资源使用，与这些诊断措施相关的死亡率，以及这些结果如何因人群亚型而异。
方法：系统文献综述是根据系统评价和荟萃分析（PRISMA）清单的首选报告项目进行的。数据来自专注于UO和SC诊断准确性的比较研究，相关临床结果，和资源使用。使用美国国家卫生与护理卓越研究所（NICE）单技术评估质量清单进行随机对照试验，并使用纽卡斯尔-渥太华质量评估量表进行观察性研究。
结果：共筛选了1729种出版物，有50项研究符合纳入条件。大多数研究（76％）使用肾脏疾病：改善全球结果（KDIGO）标准来分类AKI，并侧重于单独的UO与单独的SC的比较。虽然很少有研究基于UO和SC的存在来分析AKI的诊断，或存在UO或SC指标中的至少一个。在纳入的研究中，33%分析了接受心血管疾病治疗的患者，30%分析了在普通重症监护病房接受治疗的患者。UO标准的使用通常与AKI发生率增加相关（36％），而不是SC标准的应用(21%)，这在进行的亚组分析中是一致的。此外，UO标准的使用与AKI的早期诊断(2.4-46.0h)相关.两种诊断方式都能准确预测AKI相关死亡率的风险。
结论：证据表明，纳入UO标准对AKI的检测具有重要的诊断和预后价值。
方法：系统文献综述是根据系统评价和荟萃分析（PRISMA）清单的首选报告项目进行的。数据来自专注于UO和SC诊断准确性的比较研究，相关临床结果，和资源使用。使用美国国家卫生与护理卓越研究所（NICE）单技术评估质量清单进行随机对照试验，并使用纽卡斯尔-渥太华质量评估量表进行观察性研究。
结果：共筛选了1729种出版物，有50项研究符合纳入条件。大多数研究（76％）使用肾脏疾病：改善全球结果（KDIGO）标准来分类AKI，并侧重于单独的UO与单独的SC的比较。虽然很少有研究基于UO和SC的存在来分析AKI的诊断，或存在UO或SC指标中的至少一个。在纳入的研究中，33%分析了接受心血管疾病治疗的患者，30%分析了在普通重症监护病房接受治疗的患者。UO标准的使用通常与AKI发生率增加相关（36％），而不是SC标准的应用(21%)，这在进行的亚组分析中是一致的。此外，UO标准的使用与AKI的早期诊断(2.4-46.0h)相关.两种诊断方式都能准确预测AKI相关死亡率的风险。
结论：证据表明，纳入UO标准对AKI的检测具有重要的诊断和预后价值。
