背景:造影剂肾病(CIN)是在接受心导管插入术的患者中发生的急性肾损伤(AKI)的一种形式,例如冠状动脉造影(CAG)或经皮冠状动脉介入治疗(PCI)。尽管CIN检测的常规标准涉及造影剂注射后72小时内肌酐水平升高,这个定义存在几个限制。到目前为止,已经进行了各种荟萃分析来评估CIN预测的不同生物标志物的准确性。然而,现有的研究机构缺乏连贯的概述。为了解决这个差距,有必要进行全面的综述,以巩固和总结先前荟萃分析的结果.这项伞式研究旨在提供一种当前的,对生物标志物在预测CIN中的预后价值的循证理解
方法:对国际数据库的系统搜索,包括PubMed,Scopus,和WebofScience,从开始到2023年12月12日,我们进行了荟萃分析,以评估CIN预测的生物标志物。我们自己的荟萃分析是通过从纳入的研究中提取数据进行的。灵敏度,特异性,正似然比,使用Meta-Disc和CMA软件评估阴性似然比。
结果:12项研究最终纳入综述。结果表明,中性粒细胞明胶酶相关脂质运载蛋白(NGAL)曲线下面积(AUC)最高,其次是胱抑素C,尿肾损伤分子-1(uKIM-1),和脑钠肽(BNP)的AUC分别为0.91、0.89、0.85和0.80。NGAL还显示出最高的正似然比[效应大小(ES):6.02,95%CI3.86-9.40],其次是胱抑素C,uKIM-1和BNP[ES:4.35(95%CI2.85-6.65),3.58(95%CI2.75-4.66),和2.85(95%CI2.13-3.82),分别]。uKIM-1和胱抑素-C的阴性似然比最低,其次是NGAL和BNP[ES:0.25(95%CI0.17-0.37),ES:0.25(95%CI0.13-0.50),ES:0.26(95%CI0.17-0.41),和ES:分别为0.39(0.28-0.53)]。NGAL成为CIN诊断优势比最高的生物标志物,其次是胱抑素C,uKIM-1,BNP,γ-谷氨酰转移酶,低蛋白血症,造影剂体积与肌酐清除率,术前高血糖,红细胞分布宽度(RDW),高尿酸血症,中性粒细胞与淋巴细胞的比率,C反应蛋白(CRP),高敏CRP,血细胞比容低(P<0.05)。
结论:NGAL表现出优异的诊断性能,表现出最高的AUC,正似然比,和CIN的生物标志物之间的诊断优势比,其次是胱抑素C,还有uKIM-1.这些发现强调了NGAL的潜在临床效用,胱抑素C和uKIM-1在预测和评估CI中的作用
BACKGROUND: Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella
review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN.
METHODS: A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares.
RESULTS: Twelve studies were ultimately included in the umbrella
review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86-9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85-6.65), 3.58 (95% CI 2.75-4.66), and 2.85 (95% CI 2.13-3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17-0.37), ES: 0.25 (95% CI 0.13-0.50), ES: 0.26 (95% CI 0.17-0.41), and ES: 0.39 (0.28-0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P < 0.05).
CONCLUSIONS: NGAL demonstrated superior diagnostic performance, exhibiting the highest AUC, positive likelihood ratio, and diagnostic odds ratio among biomarkers for CIN, followed by cystatin-C, and uKIM-1. These findings underscore the potential clinical utility of NGAL, cystatin-C and uKIM-1 in predicting and assessing CIN.