Original Investigation
Pathogenesis and Treatment of Kidney Disease
Urinary, Plasma, and Serum Biomarkers’ Utility for Predicting Acute Kidney Injury Associated With Cardiac Surgery in Adults: A Meta-analysis

https://doi.org/10.1053/j.ajkd.2015.06.018Get rights and content
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Background

Early accurate detection of acute kidney injury (AKI) occurring after cardiac surgery may improve morbidity and mortality. Although several novel biomarkers have been developed for the early detection of AKI, their clinical utility in the critical intraoperative and immediate postoperative period remains unclear.

Study Design

Systematic review and meta-analysis.

Setting & Population

Adult patients having cardiac surgery.

Selection Criteria for Studies

EMBASE, CINAHL, Cochrane Library, Scopus, and PubMed from January 1990 until January 2015 were systematically searched for cohort studies reporting the utility of novel biomarkers for the early diagnosis of AKI after adult cardiac surgery. Reviewers extracted data for study design, population, timing of biomarker measurement and AKI occurrence, biomarker performance (area under the receiver operating characteristic curve [AUROC]), and risk of bias.

Index Tests

Novel urine, plasma, and serum AKI biomarkers, measured intraoperatively and in the early postoperative period (<24 hours).

Reference Tests

AKI was defined according to the RIFLE, AKIN, or 2012 KDIGO criteria.

Results

We found 28 studies reporting intraoperative and/or early postoperative measurement of urine (n = 23 studies) or plasma or serum (n = 12 studies) biomarkers. Only 4 of these studies measured biomarkers intraoperatively. Overall, intraoperative discrimination by the urine biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury marker 1 (KIM-1) demonstrated AUROCs < 0.70, whereas N-acetyl-β-d-glucosaminidase (NAG) and cystatin C had AUROCs < 0.75. In the immediate 24-hour postoperative period, the urine biomarkers NGAL (16 studies), KIM-1 (6 studies), and liver-type fatty acid binding protein (6 studies) exhibited composite AUROCs of 0.69 to 0.72. The composite AUROCs for postoperative urine cystatin C, NAG, and interleukin 18 were ≤0.70. Similarly, the composite AUROCs for postoperative plasma NGAL (6 studies) and cystatin-C (5 studies) were <0.70.

Limitations

Heterogeneous AKI definitions.

Conclusions

In adults, known urinary, plasma, and serum biomarkers of AKI possess modest discrimination at best when measured within 24 hours of cardiac surgery.

Index Words

Cardiopulmonary bypass
alpha-1-microglobulin (A1M)
hepcidin-25
liver-type fatty acid binding protein (L-FABP)
monocyte chemoattractant protein 1 (CCL2)
uric acid
tumor necrosis factor alpha (TNF-α)
acute kidney injury
biomarker
intraoperative
early postoperative
diagnostic performance

Cited by (0)

Because the Editor-in-Chief recused himself from consideration of this article, the Deputy Editor (Daniel E. Weiner, MD, MS) served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Information for Authors & Editorial Policies.