Abstract
BackgroundThe use of the furosemide stress test (FST) as an acute kidney injury (AKI) severity marker has been described in several trials. However, the diagnostic performance of the FST in predicting AKI progression has not yet been fully discussed.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, and Cochrane databases up to March 2020. The diagnostic performance of the FST (in terms of sensitivity, specificity, number of events, true positive, false positive) was extracted and evaluated.ResultsWe identified eleven trials that enrolled a total of 1366 patients, including 517 patients and 1017 patients for whom the outcomes in terms of AKI stage progression and renal replacement therapy (RRT), respectively, were reported. The pooled sensitivity and specificity results of the FST for AKI progression prediction were 0.81 (95% CI 0.74–0.87) and 0.88 (95% CI 0.82–0.92), respectively. The pooled positive likelihood ratio (LR) was 5.45 (95% CI 3.96–7.50), the pooled negative LR was 0.26 (95% CI 0.19–0.36), and the pooled diagnostic odds ratio (DOR) was 29.69 (95% CI 17.00–51.85). The summary receiver operating characteristics (SROC) with pooled diagnostic accuracy was 0.88. The diagnostic performance of the FST in predicting AKI progression was not affected by different AKI criteria or underlying chronic kidney disease. The pooled sensitivity and specificity results of the FST for RRT prediction were 0.84 (95% CI 0.72–0.91) and 0.77 (95% CI 0.64–0.87), respectively. The pooled positive LR and pooled negative LR were 3.16 (95% CI 2.06–4.86) and 0.25 (95% CI 0.14–0.44), respectively. The pooled diagnostic odds ratio (DOR) was 13.59 (95% CI 5.74–32.17), and SROC with pooled diagnostic accuracy was 0.86. The diagnostic performance of FST for RRT prediction is better in stage 1–2 AKI compared to stage 3 AKI (relative DOR 5.75, 95% CI 2.51–13.33).ConclusionThe FST is a simple tool for the identification of AKI populations at high risk of AKI progression and the need for RRT, and the diagnostic performance of FST in RRT prediction is better in early AKI population.
Highlights
The incidence of in-hospital acute kidney injury (AKI), depending on the different AKI criteria used, ranges from 7.0–18.3% [1] among hospitalized patients in general and up to 20–50% in critically ill populations [2]
In order to more effectively explore the diagnostic accuracy of the furosemide stress test (FST) to predict AKI progression and renal replacement therapy (RRT) initiation, we conducted this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagnostic test accuracy guidelines [13]
The follow-up period was unclear in the study by Venugopal et al The pooled sensitivity and specificity values were 0.48 and 0.78, Fig. 3 Forest plot of FST diagnostic accuracy for AKI progression prediction
Summary
The incidence of in-hospital acute kidney injury (AKI), depending on the different AKI criteria used, ranges from 7.0–18.3% [1] among hospitalized patients in general and up to 20–50% in critically ill populations [2]. Several following studies utilized FST to predict AKI progression or RRT prediction, but with heterogeneity in AKI criteria, cutoff value of urine output, duration of monitor, or study designs. A few recent studies used FST to predict delayed graft function after kidney transplant [9, 10], and others focused on child populations [11, 12]. The use of the furosemide stress test (FST) as an acute kidney injury (AKI) severity marker has been described in several trials. The diagnostic performance of the FST in predicting AKI progression has not yet been fully discussed
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.