Background
Methods
Study search strategy
Study selection
Data extraction and quality assessment
Statistical analysis
Results
Study characteristics and quality assessment
Study | Location | Design | Setting | AKI definition | Sepsis definition | Source | AKI/ sepsis (n) | Sampling time (hours) | Storage (°C) | NGAL assay | NGAL test kits |
---|---|---|---|---|---|---|---|---|---|---|---|
Aydogdu et al. [21] | Turkey | PC | ICU | RIFLE | SCCM/ESICM/ACCP/ATS/SIS | Urine | 63/129 | NR | −80 | ELISA | Biovendor (Brno, Southern Moravia, Czech Republic) |
Camou et al. [31] (ClinicalTrials.gov NCT01122225) | France | PC | ICU | RIFLE or AKIN | SCCM/ESICM/ACCP/ATS/SIS | Plasma | 43/50 | Admission | NR | ELISA | Triage (Biosite Inc., San Diego, CA, USA) |
de Geus et al. [34] | Netherlands | PC | ICU | AKIN | ACCP/ SCCM | Plasma | 50/75 | Admission | −80 | ELISA | Triage (Biosite Inc.) |
Fan et al. [30] | China | PC | ICU | RIFLE | SCCM/ESICM/ACCP/ATS/SIS | Urine | 58/126 | Peak | NR | RIA | – |
Hjortrup et al. [29] (ClinicalTrials.gov NCT00962156) | Denmark | PC | ICU | KDIGO | ACCP/SCCM | Plasma | 31/124 | Admission | −80 | PETIA | BioProto Diagnostics A/S (Gentofte, Denmark) |
Urine | 25/100 | −24 | |||||||||
Li and Xu [22] | China | PC | ICU | AKIN | ACCP/SCCM | Urine | 17/74 | 24 | −20 | ELISA | R&D Systems (Minneapolis, MN, USA) |
Martensson et al. [33] | Sweden | NR | ICU | RIFLE or AKIN | ACCP/SCCM | Plasma | 18/45 | 12 | NR | RIA | – |
Urine | 18/45 | NR | RIA | – | |||||||
Niu et al. [23] | China | PC | ER | AKIN | SCCM/ESICM/ACCP/ATS/SIS | Urine | 26/60 | 12 | −80 | ELISA | Hycult Biotech (Uden, North Brabant, The Netherlands) |
Shapiro et al. [24] | USA | PC | ER | RIFLE | ACCP/SCCM | Plasma | 24/66 | Admission | −70 | ELISA | Triage (Biosite Inc.) |
Si et al. [32] | Brazil | PC | ER | AKIN | SSC | Urine | 47/168 | Admission | −80 | ELISA | NR |
Wang et al. [25] | China | NR | ICU | KDIGO | ACCP/SCCM | Urine | 33/87 | 48a
| −80 | ELISA | R&D Systems |
Xing et al. [26] | China | NR | ICU | AKIN | SCCM/ESICM/ACCP/ATS/SIS | Plasma | 35/73 | NR | −80 | ELISA | R&D Systems |
Urine | 35/73 | −20 | ELISA | R&D Systems | |||||||
Yan et al. [27] | China | NR | ICU | AKIN | ACCP/SCCM | Urine | 57/112 | 2 | −80 | ELISA | R&D Systems |
Yan and Zang [28] | China | PC | ICU | AKIN | SCCM/ESICM/ACCP/ATS/SIS | Urine | 44/141 | 8 | −80 | ELISA | R&D Systems |
Zhou et al. [35] | China | NR | ICU | AKIN | SCCM/ESICM/ACCP/ATS/SIS | Urine | 46/148 | 8 | −80 | ELISA | R&D Systems |
Diagnostic performance
NGAL for prediction of AKI in septic patients
Study | AUC | 95 % CI | Cutoff value | Sensitivity (%) | Specificity (%) | Number of patients | |||
---|---|---|---|---|---|---|---|---|---|
TP rate | FP rate | FN rate | TN rate | ||||||
Aydogdu et al. [21] | 0.80 | NR | 29.5 ng/ml | 0.88 | 0.73 | 55 | 18 | 8 | 48 |
Camou et al. [31] | 0.90 | NR | 150 ng/ml | 0.93 | 0.44 | 40 | 4 | 3 | 3 |
de Geus et al. [34] | 0.80 | 0.69–0.88 | 304 ng/ml | 0.8 | 0.80 | 40 | 5 | 10 | 20 |
Fan et al. [30] | 0.86 | 0.81-0.93 | NR | 0.89 | 0.74 | 52 | 18 | 6 | 50 |
Hjortrup et al. [29] (p) | 0.66 | 0.54–0.77 | NR | 0.58 | 0.76 | 18 | 22 | 13 | 71 |
Hjortrup et al. [29] (u) | 0.71 | 0.59–0.82 | NR | 0.56 | 0.72 | 14 | 21 | 11 | 54 |
Li and Xu [22] | 0.94 | 0.68-0.97 | 50 μg/l | 0.94 | 0.88 | 16 | 7 | 1 | 50 |
Martensson et al. [33] (p) | 0.85 | 0.39-0.94 | >120 ng/ml | 0.83 | 0.86 | 15 | 4 | 3 | 23 |
Martensson et al. [33] (u) | 0.86 | 0.68-1.00 | >68 ng/mg.scr | 0.71 | 1.00 | 13 | 0 | 5 | 27 |
Niu et al. [23] | 0.91 | NR | 52 μg/g · scr | 0.88 | 0.87 | 23 | 5 | 3 | 29 |
Shapiro et al. [24] | 0.82 | 0.76-0.88 | NR | 0.96 | 0.51 | 23 | 312 | 1 | 325 |
Si et al. [32] | 0.73 | 0.64-0.82 | 3.36 ng/ml | 0.63 | 0.46 | 76 | 25 | 45 | 22 |
Wang et al. [25] | 0.81 | 0.71-0.91 | 150 ng/ml | 0.79 | 0.90 | 26 | 5 | 7 | 49 |
Xing et al. [26] (p) | 0.86 | 0.77-0.94 | 92.5 ng/ml | 0.85 | 0.87 | 30 | 5 | 5 | 33 |
Xing et al. [26] (u) | 0.93 | 0.88-0.93 | 118.5 ng/ml | 0.93 | 0.89 | 32 | 4 | 3 | 34 |
Yan et al. [27] | 0.93 | 0.88-0.98 | 65 μg/l | 0.95 | 0.86 | 54 | 8 | 3 | 47 |
Yan and Xang [28] | 0.86 | 0.70-0.96 | 90 μg/l | 0.87 | 0.86 | 38 | 14 | 6 | 83 |
Zhou et al. [35] | 0.80 | 0.7 l-0.93 | 85 ng/l | 0.78 | 0.80 | 36 | 20 | 10 | 82 |
Study | Sensitivity | Specificity | Positive likelihood ratio | Negative likelihood ratio | Diagnostic odds ratio | AUC |
---|---|---|---|---|---|---|
(95 % CI) | (95 % CI) | (95 % CI) | (95 % CI) | (95 % CI) | ||
Total | 0.83 (0.77–0.88) | 0.57 (0.54–0.61) | 3.10 (1.57–6.11) | 0.24 (0.13–0.43) | 14.72 (6.55–33.10) | 0.86 |
Camou et al. [31] | 0.80 ( 0.73–0.86) | 0.58 (0.54–0.61) | 3.59 (1.45–8.88) | 0.25 (0.13–0.48) | 15.93 (6.21–40.85) | 0.87 |
de Geus et al. [34] | 0.83 (0.77–0.89) | 0.57 (0.53–0.60) | 2.94 (1.45–5.93) | 0.22 (0.10–0.50) | 14.98 (5.37–41.80) | 0.86 |
Hjortrup et al. [29] | 0.87 (0.81–0.92) | 0.55 (0.51–0.59) | 3.33 (1.23–9.03) | 0.20 (0.13–0.30) | 22.13 (11.20–43.73) | 0.90 |
Martensson et al. [33] | 0.83 (0.76–0.88) | 0.57 (0.53–0.60) | 2.78 (1.43–5.41) | 0.24 (0.12–0.48) | 13.27 (5.35–32.93) | 0.85 |
Shapiro et al. [24] | 0.81 (0.74–0.86) | 0.79 (0.72–0.85) | 3.34 (1.98–5.64) | 0.26 (0.15–0.47) | 14.03 (5.66–34.77) | 0.86 |
Xing et al. [26] | 0.82 (0.75–0.87) | 0.56 (0.52–0.60) | 2.63 (1.51–4.59) | 0.26 (0.14–0.50) | 11.38 (5.11–25.31) | 0.83 |
Variance | Number | Sensitivity | Specificity | Positive likelihood ratio | Negative likelihood ratio | Diagnostic odds ratio | AUC | Coeff. | SE |
P value | RDOR (95 % CI) | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
(95 % CI) | (95 % CI) | (95 % CI) | (95 % CI) | (95 % CI) | ||||||||
Setting | ICU | 10 | 0.85 (0.81–0.88) | 0.82 (0.79–0.85) | 4.73 (3.41–6.55) | 0.19 (0.12–0.31) | 29.05 (14.29–59.02) | 0.91 | –0.96 | 1.16 | 0.45 | 0.38 (0.02–9.57) |
ER | 2 | 0.67 (0.59–0.75) | 0.63 (0.52–0.73) | 2.56 (0.48–13.65) | 0.35 (0.05–2.34) | 7.57 (0.27–216.18) | – | |||||
Design | Prospective | 7 | 0.77 (0.73–0.82) | 0.76 (0.71–0.80) | 3.41 (1.98–5.85) | 0.24 (0.11–0.50) | 15.00 (4.58–49.14) | 0.84 | 0.16 | 0.80 | 0.85 | 1.18 (0.13–10.85) |
Nonprospective | 5 | 0.85 (0.79–0.90) | 0.87 (0.82–0.90) | 6.40 (3.94–10.40) | 0.19 (0.11–0.32) | 45.65 (18.15–114.83) | 0.94 | |||||
Number of cases | ≥100 | 7 | 0.87 (0.74–0.82) | 0.76 (0.72–0.79) | 3.20 (1.95–5.24) | 0.24 (0.12–0.49) | 13.62 (4.53–40.98) | 0.82 | 1.33 | 0.84 | 0.19 | 3.77 (0.37–38.63) |
<100 | 5 | 0.85 (0.78–0.91) | 0.90 (0.85–0.94) | 7.85(5.24–11.74) | 0.18 (0.11–0.30) | 58.18 (27.63–122.49) | 0.95 | |||||
NGAL test method | ELISA | 9 | 0.81 (0.77–0.84) | 0.81 (0.77–0.84) | 4.79 (2.76–8.32) | 0.18 (0.09–0.35) | 28.07 (9.47–83.18) | 0.91 | 0.51 | 1.01 | 0.64 | 1.66 (0.10–26.97) |
Non-ELISA | 3 | 0.78 (0.69–0.86) | 0.77 (0.70–0.83) | 3.16 (1.46–6.82) | 0.31 (0.12–0.76) | 15.56 (2.42–100.09) | 0.86 | |||||
Location | Asia | 9 | 0.88 (0.84–0.91) | 0.83 (0.79–0.86) | 5.01 (3.87–6.49) | 0.17 (0.12–0.22) | 33.05 (20.72–52.72) | 0.92 | –1.23 | 1.30 | 0.40 | 0.29 (0.01–10.88) |
Others | 3 | 0.63 (0.55–0.70) | 0.69 (0.61–0.76) | 1.99 (0.83–4.76) | 0.56 (0.34–0.93) | 4.34 (0.96–19.62) | 0.64 | |||||
Language | English | 5 | 0.74 (0.68–0.79) | 0.71 (0.65–0.76) | 2.51 (1.38–4.57) | 0.34 (0.17–0.69) | 9.36 (2.40–36.54) | 0.83 | 0.60 | 1.04 | 0.59 | 1.82 (0.10–32.62.) |
Chinese | 7 | 0.87 (0.83–0.91) | 0.86 (0.82–0.89) | 5.77 (4.56–7.30) | 0.16 (0.10–0.24) | 41.64 (22.82–75.97) | 0.93 |
NGAL for prediction of RRT in septic patients with AKI
NGAL for prediction of mortality in septic patients with AKI
Discussion
Conclusion
Key messages
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AKI is a widespread problem in critically ill patients, and sepsis is a well-known precipitating factor for the development of AKI.
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NGAL is not only an effective predictive factor for AKI in the process of sepsis, but also shows potential value for RRT and mortality.