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Meta-Analysis
. 2015 Feb;28(1):7-16.
doi: 10.1007/s40620-014-0113-9. Epub 2014 Jun 5.

Urine interleukin-18 in prediction of acute kidney injury: a systemic review and meta-analysis

Xin Lin  1 , Jing Yuan, Yingting Zhao, Yan Zha
Affiliations
Meta-Analysis

Urine interleukin-18 in prediction of acute kidney injury: a systemic review and meta-analysis

Xin Lin et al. J Nephrol. 2015 Feb.

Abstract

Background: Interleukin-18 (IL-18) mediates ischemic acute tubular necrosis; it has been proved as a rapid, reliable, and affordable test marker for the early detection of acute kidney injury (AKI), but its predictive accuracy varies greatly.

Methods: MEDLINE and EMBASE, Cochrane Library, Ovid, and Springerlink (from inception to November 15, 2013) were searched for relevant studies (in English) investigating diagnostic accuracy of urine IL-18 to predict AKI in various clinical settings. The text index was increasing or increased urine IL-18 level and the main outcome was the development of AKI, which was primarily based on serum creatinine level [using risk, injury, failure, loss and end-stage renal disease (RIFLE), acute kidney injury network, or modified pediatric RIFLE criteria in pediatric patients]. Pooled estimates of diagnostic odds ratio (OR), sensitivity and specificity were calculated. Summary receiver operating characteristic curves were used to calculate the measures of accuracy and Q point value (Q*). Remarkable heterogeneity was explored further by subgroup analysis based on the different clinical settings.

Results: We analyzed data from 11 studies of 3 countries covering 2,796 patients. These studies were marked by limitations of threshold and non-threshold effect heterogeneity. Across all settings, the diagnostic OR for urine IL-18 level to predict AKI was 5.11 [95% confidence interval (CI) 3.22-8.12], with sensitivity and specificity respectively at 0.51 and 0.79. The area under the ROC curve of urine IL-18 level to predict AKI was 0.77 (95% CI 0.71-0.83). Subgroup analysis showed that urine IL-18 level in pediatric patients (<18 years) and early AKI predictive time (<12 h) were more effective in predicting AKI, with diagnostic ORs of 7.51 (2.99-18.88), 8.18 (2.19-30.51), respectively.

Conclusion: Urine IL-18 holds promise as a biomarker in the prediction of AKI but has only moderate diagnostic value.

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Figures

Fig. 1
Fig. 1
Flowchart representing study selection for systematic review of urine IL-18 as a diagnostic marker for AKI. IL interleukin, AKI acute kidney injury
Fig. 2
Fig. 2
The distribution of accurate estimator in sROC curve floor plan. sROC summary receiver operating characteristic
Fig. 3
Fig. 3
Forest plots and pooled estimates of a diagnostic odds ratio (OR), b sensitivity, and c specificity
Fig. 4
Fig. 4
The fitting curve of sROC
See this image and copyright information in PMC

References

    1. Fuchs L, Lee J, Novack V, et al. Severity of acute kidney injury and two-year outcomes in critically ill patients. Chest. 2013;144(3):866–875. doi: 10.1378/chest.12-2967. - DOI - PMC - PubMed
    1. Herget-Rosenthal S, Marggraf G, Hüsing J, et al. Early detection of acute renal failure by serum cystatin C. Kidney Int. 2004;66(3):1115–1122. doi: 10.1111/j.1523-1755.2004.00861.x. - DOI - PubMed
    1. Dinarello CA. Interleukin-18 and the pathogenesis of inflammatory diseases. Semin Nephron. 2007;27(1):98–114. doi: 10.1016/j.semnephrol.2006.09.013. - DOI - PubMed
    1. Award AS, El-sharif AA. Curcumin immune-mediated and anti-apoptotic mechanisms protect against renal ischemia/reperfusion and distant organ induced injuries. Int Immunopharmacol. 2011;11(8):992–996. doi: 10.1016/j.intimp.2011.02.015. - DOI - PubMed
    1. Luo Q, Zhou F, Dong H, et al. Implication of combined urinary biomarkers in early diagnosis of acute kidney injury following percutaneous coronary intervention. Clin Nephrol. 2013;79(2):85–92. doi: 10.5414/CN106852. - DOI - PubMed