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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Diagnosis and prognosis of neutrophil gelatinase-associated lipocalin for acute kidney injury with sepsis: a systematic review and meta-analysis

Authors: An Zhang, Ying Cai, Peng-Fei Wang, Jian-Ning Qu, Zhen-Chun Luo, Xiao-Dong Chen, Bin Huang, Yi Liu, Wen-Qi Huang, Jing Wu, Yue-Hui Yin

Published in: Critical Care | Issue 1/2016

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Abstract

Background

Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as an early biomarker for prediction of acute kidney injury (AKI). However, the utility of NGAL to predict the occurrence of AKI in septic patients remains controversial. We performed a systematic review and meta-analysis to evaluate the evidence on diagnosis of sepsis AKI and the prediction of other clinical outcomes.

Method

The MEDLINE, EMBASE, Cochrane Library, Wanfang, and CNKI databases were systematically searched up to August 19, 2015. Quality assessment was applied by using the Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tool. The diagnostic performance of NGAL for the prediction of AKI in sepsis was evaluated using pooled estimates of sensitivity, specificity, likelihood ratio, and diagnostic odds ratio (DOR), as well as summary receiver operating characteristic curves (SROC).

Results

Fifteen studies with a total of 1,478 patients were included in the meta-analysis. For plasma NGAL, the pooled sensitivity and specificity with corresponding 95 % confidence intervals (CI) were 0.83 (95 % CI: 0.77 − 0.88) and 0.57 (95 % CI: 0.54 − 0.61), respectively. The pooled positive likelihood ratio (PLR) was 3.10 (95 % CI: 1.57 − 6.11) and the pooled negative likelihood ratio (NLR) was 0.24 (95 % CI: 0.13 − 0.43). The pooled DOR was 14.72 (95 % CI: 6.55 − 33.10) using a random effects model. The area under the curve (AUC) for SROC to summarize diagnostic accuracy was 0.86. For urine NGAL, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC values were 0.80 (95 % CI: 0.77 − 0.83), 0.80 (95 % CI: 0.77 − 0.83), 4.42 (95 % CI: 2.84 − 6.89), 0.21 (95 % CI: 0.13 − 0.35), 24.20 (95 % CI: 9.92 − 59.05) and 0.90, respectively. Significant heterogeneity was explored as a potential source. There was no notable publication bias observed across the eligible studies. NGAL for prediction of renal replacement therapy (RRT) and mortality associated with AKI in septic patients were also evaluated.

Conclusion

To a certain extent, NGAL is not only an effective predictive factor for AKI in the process of sepsis, but also shows potential predictive value for RRT and mortality. However, future trials are needed to clarify this controversial issue.
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Metadata
Title
Diagnosis and prognosis of neutrophil gelatinase-associated lipocalin for acute kidney injury with sepsis: a systematic review and meta-analysis
Authors
An Zhang
Ying Cai
Peng-Fei Wang
Jian-Ning Qu
Zhen-Chun Luo
Xiao-Dong Chen
Bin Huang
Yi Liu
Wen-Qi Huang
Jing Wu
Yue-Hui Yin
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1212-x

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