Introduction
Methods
Data sources and search strategy
Study selection
Data extraction
Statistical analysis
Results
Search results and study characteristics
Study (first author + year) | Country of origin | Study population | Mean age (years) | Men (%) | Sample size | Number (%) of AKI | Mean baseline IL-18 (pg/ml) | Definition of AKI | IL-18 Assay | Sample storage (°C) |
---|---|---|---|---|---|---|---|---|---|---|
Zheng et al. [6] | China | Children with CHD or undergoing CPB surgery | Non-AKI 11.4 (2.2–47.0) AKI 5.9 (0.6–44.5)a
| 39 (67.2) | 58 | 29 (50) | Non-AKI 7.9 (3.8–23.1) AKI 17.6 (7.2–41.5) | SCr↑ ≥0.3 mg/dl or ≥50 % baseline, urine ≤0.5 ml/kg/6 h AKIN criteria | ELISA | –80 |
Sirota et al. [7] | USA | Orthotopic liver transplantation patients | 56.1 ± 6.8 | 27 (67.5) | 40 | 7 (17.5) | AKI 0 (0–18.57) Non-AKI 0 (0–200.10) | SCr↑ ≥50 % baseline, RIFLE and AKIN criteria | ELISA | –80 |
Li et al. [11] | China | Non-septic critically ill neonates | 34.1 ± 3.2b
| 34 (54.8) | 62 | 11 (17.7) | / | SCr >1.5 mg/dl on the first 3 days of life, after the first 3 days of life, a ≥25 % decrease in eCCl. Modified pediatric RIFLE | ELISA | –80 |
Chen et al. [12] | Taiwan, China | CCU patients | 66 ± 1 | 113 (75) | 150 | 43 (28.7) | 71 ± 5 | AKIN criteria | ELISA | –80 |
Parikh et al. [13] | USA | Pediatric patients with congenital cardiac lesions surgery | 3.8 ± 4.5 | 171 (55) | 311 | 53 (17.0) | / | Receipt of acute dialysis during the entire hospital stay or sCr double baseline. RIFLE R or AKIN stage 2 | ELISA | –80 |
Parikh et al. [14] | USA | Cardiac surgery adults at high risk for AKI | 71 ± 10 | 826 (68) | 1219 | 60 (4.9) | / | Receipt of acute dialysis during the entire hospital stay or sCr double baseline. RIFLE R or AKIN stage 2 | ELISA | –80 |
Endre et al. [15] | Australia | ICU admission | 60 ± 17 | 367 (70.2) | 523 | 147 (28.1) | 73 ± 340c
| SCr↑ ≥0.3 mg/dl or 50 % baseline AKIN48 or RIFLE 24 criteria | ELISA | –80 |
Liangos et al. [16] | USA | Patients undergoing on-pump cardiac surgery | 68 ± 11 | 74 (72) | 103 | 13 (12.6) | / | Scr↑ ≥50 % baseline in the first 72 h following termination of CPB | ELISA | –80 |
Washburn et al. [17] | USA | PICU children who received mechanical ventilation | 6.5 ± 6.4 | 73 (53) | 137 | 103 (75.2) | 179.0 ± 337.9 | Paediatric modified RIFLE | ELISA | –80 |
Parikh et al. [18] | USA | Cardiac surgery children | 3.4 ± 5.3 | 30 (54.5) | 55 | 20 (36.4) | 1.65 ± 1.01 | SCr↑ ≥50 % baseline | ELISA | –80 |
Parikh et al. [19] | USA | ARDS and ALI patient | 50.2 ± 17.0 | 72 (52.2) | 138 | 52 (37.7) | AKI 104 (0–955) Control 0 (0–173) | SCr↑ ≥50 % baseline | ELISA | –80 |
Quality assessment
Study | Study design | Spectrum biasa
| Eligibility criteria clearly defined | Appropriate reference standard | Differential verification biasb
| Index test and reference standard sufficiently described | Selective loss during followupc
| Important confounders identified |
---|---|---|---|---|---|---|---|---|
Zheng et al. [6] | Prospective study | No | Yes | Yes | Yes | Yes | No | Yes |
Sirota et al. [7] | Retrospective and prospective study | No | Yes | Yes | Yes | Yes | – | Yes |
Li et al. [11] | Prospective study | No | Yes | Yes | Yes | Yes | No | Yes |
Chen et al. [12] | Prospective study | No | No | Yes | Yes | Yes | No | Yes |
Parikh et al. [13] | Prospective, multicenter cohort study | No | Yes | Yes | Yes | Yes | No | Yes |
Parikh et al. [14] | Prospective, multicenter cohort study | No | Yes | Yes | Yes | Yes | No | Yes |
Endre et al. [15] | Prospective observational study | No | Yes | Yes | Yes | Yes | No | Yes |
Liangos et al. [16] | Prospective cohort study | No | Yes | Yes | Yes | Yes | No | Yes |
Washburn et al. [17] | Prospective study | No | Yes | Yes | Yes | Yes | No | Yes |
Parikh et al. [18] | Prospective study | No | Yes | Yes | Yes | Yes | No | Yes |
Parikh et al. [19] | Prospective study | No | Yes | Yes | Yes | Yes | No | Yes |
Data extraction and calculation
Study | Time of obtaining specimen | TP | FP | FN | TN | Cutoff value (pg/ml) | Sensitivity (%) | Specificity (%) | AUROC (95 % CI) | Assess time (h) |
---|---|---|---|---|---|---|---|---|---|---|
Zheng et al. [6] | 0, 4, 6, 12, and 24 h after the initiation of CPB | 28 | 11 | 1 | 18 | 49 | 96.60 | 62.10 | 0.835 (0.729–0.940) | 4 |
Sirota1 et al. [7] | 24 h after orthotopic liver transplantation | 5 | 7 | 2 | 26 | / | 72 | 79 | 0.749 | 24 |
Li et al. [11] | 48 h admitted | 7 | 4 | 4 | 47 | 1,800a
| 64 | 92 | 0.72 (0.52–0.93) | 48 |
Chen et al. [12] | Admission | 22 | 17 | 22 | 90 | 70 | 50 | 84 | 0.621 (0.504–0.738) | 48 |
Parikh et al. [13] | Admission | 37 | 83 | 16 | 175 | 125 | 69 | 68 | 0.72 (0.64–0.80) | 48 |
Parikh et al. [14] | Admission, every 6 h | 32 | 209 | 28 | 950 | 60 | 54 | 82 | 0.74 (0.66–0.81) | 48 |
Endre et al. [15] | Admission | 50 | 83 | 97 | 293 | 36b
| 34 | 78 | 0.62 (0.56–0.67) | 0 |
Liangos et al. [16] | 2 h post-cardiopulmonary bypass | 10 | 31 | 3 | 59 | 92 | 75 | 66 | 0.66 (0.49–0.83) | 2 |
Washburn et al. [17] | 2 PM each day | 39 | 7 | 64 | 27 | 75 | 38 | 78 | 0.54 (0.31–0.77) | 24 |
55 | 10 | 48 | 24 | 75 | 53 | 71 | 0.61 (0.43 –0.78) | 48 | ||
Parikh et al. [18] | Every 2 h for the first 12 h and then once every 12 h | 5 | 1 | 15 | 34 | 50 | 25 | 97 | 0.61 | 4 |
10 | 2 | 10 | 33 | 50 | 50 | 94 | 0.75 | 12 | ||
12 | 4 | 8 | 31 | 20 | 60 | 89 | 0.73 | 24 | ||
Parikh et al. [19] | Days 0, 1, and 3 | 38 | 29 | 14 | 57 | 25 | 74 | 66 | 0.731 | 24 |
Diagnostic value of urine IL-18 in AKI prediction
Spearman correlation coefficient: 0.764, p value = 0.006 | ||||
---|---|---|---|---|
Logit (TPR) vs. logit (FPR) | ||||
Moses’ model (D = a + bS) | ||||
Weighted regression (inverse variance) | ||||
Var | Coeff. | Std. error | T |
p value |
a | 1.791 | 0.254 | 7.061 | 0.0001 |
b(1) | 0.224 | 0.157 | 1.428 | 0.1870 |
Subgroup factors | Subgroup criteria | Reference numbers | Q value | P value | I2 (%) | Hierarchical summary OR (95 % CI) | P value for between subgroups |
---|---|---|---|---|---|---|---|
Age | <18 years | 5 | 10.23 | 0.037 | 60.9 | 7.51 (2.99–18.88) | 0.334 |
≥18 years | 6 | 15.54 | 0.008 | 67.8 | 4.32 (2.48–7.51) | ||
Predictive time | ≤12 h | 5 | 18.27 | 0.001 | 78.1 | 8.18 (2.19–30.51) | 0.037 |
24 h | 4 | 4.48 | 0.214 | 33.0 | 5.07 (2.58–9.96) | ||
48 h | 5 | 5.04 | 0.283 | 20.7 | 4.95 (3.39–7.24) | ||
Obtaining specimen | Admission | 4 | 13.4 | 0.004 | 77.6 | 3.81 (2.08–6.99) | 0.388 |
Other times | 7 | 10.38 | 0.109 | 42.4 | 7.16 (3.62–14.18) | ||
Patients | Cardiac surgery | 4 | 0.59 | 0.90 | 0.01 | 5.28 (3.593–7.762) | 0.008 |
Other patients | 7 | 23.28 | 0.001 | 74.2 | 5.31 (2.59–10.87) |