■胱抑素C,中性粒细胞明胶酶相关脂质运载蛋白(NGAL),肾损伤分子(KIM)-1是肾脏生物标志物,因其在心力衰竭(HF)患者的危险分层和预后中的作用而日益受到重视。然而,很少被临床采用,由于缺乏一致性。
■作者旨在研究胱抑素C,NGAL,KIM-1和结果,死亡率,住院治疗,急性和慢性HF患者的肾功能(WRF)恶化。
■我们收录了PubMed和EMBASE在2021年12月之前发表的同行评审英语文章。我们使用随机效应荟萃分析分析了上述关联。使用漏斗图评估出版偏倚。
■在2,631篇文章中,100篇文章,包括45428名患者,符合纳入标准。血清胱抑素C,与底层相比,对于死亡率(pHR:1.59,95%CI:1.42-1.77)和死亡率和HF住院的复合结局(pHR:1.49,95%CI:1.23-1.75),合并风险比(pHR)较高.血清NGAL的最高比例对死亡率(pHR:2.91,95%CI:1.49-5.67)和复合结局(HR:4.11,95%CI:2.69-6.30)有更高的风险。血清和尿液NGAL与WRF显著相关,pHR为2.40(95%CI:1.48-3.90)和2.01(95%CI:1.21-3.35)。尿液KIM-1与WRF(pHR:1.60,95%CI:1.24-2.07)显着相关,但与其他结局无关。研究之间的异质性很高,没有基于元回归的明显解释。
■血清胱抑素C和血清NGAL是HF不良结局的独立预测因子。血清和尿液NGAL是HF中WRF的重要预测因子。
UNASSIGNED: Cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule (KIM)-1 are renal biomarkers increasingly appreciated for their role in the risk stratification and prognostication of heart failure (HF) patients. However, very few have been adopted clinically, owing to the lack of consistency.
UNASSIGNED: The authors aimed to study the association between cystatin C, NGAL, and KIM-1 and outcomes, mortality, hospitalizations, and worsening renal function (WRF) in patients with acute and chronic HF.
UNASSIGNED: We included peer-reviewed English-language articles from PubMed and EMBASE published up to December 2021. We analyzed the above associations using random-effects meta-analysis. Publication bias was assessed using funnel plots.
UNASSIGNED: Among 2,631 articles, 100 articles, including 45,428 patients, met the inclusion criteria. Top-tertile of serum cystatin C, when compared to the bottom-tertile, carried a higher pooled hazard ratio (pHR) for mortality (pHR: 1.59, 95% CI: 1.42-1.77) and for the composite outcome of mortality and HF hospitalizations (pHR: 1.49, 95% CI: 1.23-1.75). Top-tertile of serum NGAL had a higher hazard for mortality (pHR: 2.91, 95% CI: 1.49-5.67) and composite outcome (HR: 4.11, 95% CI: 2.69-6.30). Serum and urine NGAL were significantly associated with WRF, with pHRs of 2.40 (95% CI: 1.48-3.90) and 2.01 (95% CI: 1.21-3.35). Urine KIM-1 was significantly associated with WRF (pHR: 1.60, 95% CI: 1.24-2.07) but not with other outcomes. High heterogeneity was noted between studies without an obvious explanation based on meta-regression.
UNASSIGNED: Serum cystatin C and serum NGAL are independent predictors of adverse outcomes in HF. Serum and urine NGAL are important predictors of WRF in HF.