Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis
Abstract Introduction Acute kidney injury (AKI) develops in 20–50% of patients undergoing cardiac surgery (CS). We aimed to assess the predictive value of urinary biomarkers (UBs) for predicting CS-associated AKI. We also aimed to investigate the accuracy of the combination of UB measurements and th...
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| Format: | Article |
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SpringerOpen
2025-03-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01459-7 |
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| author | Nikolett Kiss Márton Papp Caner Turan Tamás Kói Krisztina Madách Péter Hegyi László Zubek Zsolt Molnár |
| author_facet | Nikolett Kiss Márton Papp Caner Turan Tamás Kói Krisztina Madách Péter Hegyi László Zubek Zsolt Molnár |
| author_sort | Nikolett Kiss |
| collection | DOAJ |
| description | Abstract Introduction Acute kidney injury (AKI) develops in 20–50% of patients undergoing cardiac surgery (CS). We aimed to assess the predictive value of urinary biomarkers (UBs) for predicting CS-associated AKI. We also aimed to investigate the accuracy of the combination of UB measurements and their incorporation in predictive models to guide physicians in identifying patients developing CS-associated AKI. Methods All clinical studies reporting on the diagnostic accuracy of individual or combined UBs were eligible for inclusion. We searched three databases (MEDLINE, EMBASE, and CENTRAL) without any filters or restrictions on the 11th of November, 2022 and reperformed our search on the 3rd of November 2024. Random and mixed effects models were used for meta-analysis. The main effect measure was the area under the Receiver Operating Characteristics curve (AUC). Our primary outcome was the predictive values of each individual UB at different time point measurements to identify patients developing acute kidney injury (KDIGO). As a secondary outcome, we calculated the performance of combinations of UBs and clinical models enhanced by UBs. Results We screened 13,908 records and included 95 articles (both randomised and non-randomised studies) in the analysis. The predictive value of UBs measured in the intraoperative and early postoperative period was at maximum acceptable, with the highest AUCs of 0.74 [95% CI 0.68, 0.81], 0.73 [0.65, 0.82] and 0.74 [0.72, 0.77] for predicting severe CS-AKI, respectively. To predict all stages of CS-AKI, UBs measured in the intraoperative and early postoperative period yielded AUCs of 0.75 [0.67, 0.82] and 0.73 [0.54, 0.92]. To identify all and severe cases of acute kidney injury, combinations of UB measurements had AUCs of 0.82 [0.75, 0.88] and 0.85 [0.79, 0.91], respectively. Conclusion The combination of urinary biomarkers measurements leads to good accuracy. |
| format | Article |
| id | doaj-art-bd63c20dd7bc4786b4531f53e19f62b2 |
| institution | DOAJ |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-bd63c20dd7bc4786b4531f53e19f62b22025-08-20T02:49:01ZengSpringerOpenAnnals of Intensive Care2110-58202025-03-0115111710.1186/s13613-025-01459-7Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysisNikolett Kiss0Márton Papp1Caner Turan2Tamás Kói3Krisztina Madách4Péter Hegyi5László Zubek6Zsolt Molnár7Centre for Translational Medicine, Semmelweis UniversityCentre for Translational Medicine, Semmelweis UniversityCentre for Translational Medicine, Semmelweis UniversityCentre for Translational Medicine, Semmelweis UniversityCentre for Translational Medicine, Semmelweis UniversityCentre for Translational Medicine, Semmelweis UniversityCentre for Translational Medicine, Semmelweis UniversityCentre for Translational Medicine, Semmelweis UniversityAbstract Introduction Acute kidney injury (AKI) develops in 20–50% of patients undergoing cardiac surgery (CS). We aimed to assess the predictive value of urinary biomarkers (UBs) for predicting CS-associated AKI. We also aimed to investigate the accuracy of the combination of UB measurements and their incorporation in predictive models to guide physicians in identifying patients developing CS-associated AKI. Methods All clinical studies reporting on the diagnostic accuracy of individual or combined UBs were eligible for inclusion. We searched three databases (MEDLINE, EMBASE, and CENTRAL) without any filters or restrictions on the 11th of November, 2022 and reperformed our search on the 3rd of November 2024. Random and mixed effects models were used for meta-analysis. The main effect measure was the area under the Receiver Operating Characteristics curve (AUC). Our primary outcome was the predictive values of each individual UB at different time point measurements to identify patients developing acute kidney injury (KDIGO). As a secondary outcome, we calculated the performance of combinations of UBs and clinical models enhanced by UBs. Results We screened 13,908 records and included 95 articles (both randomised and non-randomised studies) in the analysis. The predictive value of UBs measured in the intraoperative and early postoperative period was at maximum acceptable, with the highest AUCs of 0.74 [95% CI 0.68, 0.81], 0.73 [0.65, 0.82] and 0.74 [0.72, 0.77] for predicting severe CS-AKI, respectively. To predict all stages of CS-AKI, UBs measured in the intraoperative and early postoperative period yielded AUCs of 0.75 [0.67, 0.82] and 0.73 [0.54, 0.92]. To identify all and severe cases of acute kidney injury, combinations of UB measurements had AUCs of 0.82 [0.75, 0.88] and 0.85 [0.79, 0.91], respectively. Conclusion The combination of urinary biomarkers measurements leads to good accuracy.https://doi.org/10.1186/s13613-025-01459-7Cardiac surgery-associated acute kidney injuryUrinary biomarkersAccuracyPredictive valueIntraoperativePostoperative |
| spellingShingle | Nikolett Kiss Márton Papp Caner Turan Tamás Kói Krisztina Madách Péter Hegyi László Zubek Zsolt Molnár Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis Annals of Intensive Care Cardiac surgery-associated acute kidney injury Urinary biomarkers Accuracy Predictive value Intraoperative Postoperative |
| title | Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis |
| title_full | Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis |
| title_fullStr | Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis |
| title_full_unstemmed | Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis |
| title_short | Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis |
| title_sort | combination of urinary biomarkers can predict cardiac surgery associated acute kidney injury a systematic review and meta analysis |
| topic | Cardiac surgery-associated acute kidney injury Urinary biomarkers Accuracy Predictive value Intraoperative Postoperative |
| url | https://doi.org/10.1186/s13613-025-01459-7 |
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