Predictive value of cystatin C and neutrophil gelatinase-associated lipocalin in contrast-induced nephropathy: Ameta-analysis.

Yi He,Junxiang Chen,Siyao Li,Jing Xi,Kaiting Zhuang,Yunzhen Deng,Emmanuel A Burdmann

doi:10.1371/journal.pone.0230934

Abstract

There are still limited studies comprehensively examining the diagnostic performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in contrast-induced nephropathy (CIN). The study aimed to investigate and compare the predictive value of NGAL and cystatin C in the early diagnosis of CIN. We searched the PubMed, EMBASE and Cochrane Library databases until November 10, 2019. The methodological quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) modeling were performed to summarize and compare the diagnostic performance of blood/urine NGAL and serum cystatin C in CIN. Subgroup and meta-regression analyses were performed according to the study and patient characteristics. Thirty-seven studies from thirty-one original studies were included (blood NGAL, 1840 patients in 9 studies; urine NGAL, 1701 patients in 10 studies; serum cystatin C, 5509 patients in 18 studies). Overall, serum cystatin C performed better than serum/urine NGAL (pooled DOR: 43 (95%CI: 12-152); AUROC: 0.93; λ: 3.79); serum and urine NGAL had a similar diagnostic performance (pooled DOR: 25 (95%CI: 6-108)/22(95%CI: 8-64); AUROC: 0.90/0.89; λ: 3.20/3.08). Meta-regression analysis indicated that the sources of heterogeneity might be CIN definition, assays, and nationalities. Both NGAL and cystatin C can serve as early diagnostic indicators of CIN, while cystatin C may perform better than NGAL.

Highlights

Contrast-induced nephropathy (CIN) is defined as acute kidney injury (AKI) occurring 24–72 h after radiographic contrast media (CM) exposure in the absence of an alternative etiology[1]
Both neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C can serve as early diagnostic indicators of contrast-induced nephropathy (CIN), while cystatin C may perform better than NGAL
The results indicated that blood NGAL may perform better than urine NGAL within 6 h after contrast media exposure; after 6 h, urine NGAL might be a better predictor of CIN than blood NGAL

Summary

Introduction

Contrast-induced nephropathy (CIN) is defined as acute kidney injury (AKI) occurring 24–72 h after radiographic contrast media (CM) exposure in the absence of an alternative etiology[1]. The diagnosis of CIN is based on the variation in serum creatinine (sCr) levels before and after CM exposure. After the kidneys undergo a contrast-induced toxicity attack, sCr typically increases within the first 24–48 h, peaks at 3–5 days and returns near baseline within 1–3 weeks[6]. Since there are so many limitations of sCr, the urgency for finding specific and sensitive biomarkers is highlighted. There are still limited studies comprehensively examining the diagnostic performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in contrast-induced nephropathy (CIN).

Methods

Results

Conclusion