Evaluating biomarkers for contrast-induced nephropathy following coronary interventions: an umbrella review on meta-analyses

Abstract

Background: Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN.

Methods: A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares.

Results: Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86-9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85-6.65), 3.58 (95% CI 2.75-4.66), and 2.85 (95% CI 2.13-3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17-0.37), ES: 0.25 (95% CI 0.13-0.50), ES: 0.26 (95% CI 0.17-0.41), and ES: 0.39 (0.28-0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P < 0.05).

Conclusion: NGAL demonstrated superior diagnostic performance, exhibiting the highest AUC, positive likelihood ratio, and diagnostic odds ratio among biomarkers for CIN, followed by cystatin-C, and uKIM-1. These findings underscore the potential clinical utility of NGAL, cystatin-C and uKIM-1 in predicting and assessing CIN.

Keywords: Biomarkers; Cardiac catheterization; Contrast induced nephropathy; Coronary angiography; Meta-analysis; Percutaneous coronary intervention; Predicators; Umbrella review.

Fig. 1

Study selection process

Fig. 2

Summary receiver operating characteristics (SROC). A SROC for Cystatin-C, B SROC for BNP, C SROC for uKIM-1, D SROC for NGAL

Fig. 3

Diagnostic odds ratio of biomarkers

Fig. 4

Results of prediction interval of the biomarkers. A Hypoalbuminemia, B Hyperuricemia, C BUN, D CRP, E hs-CRP, F NLR, G RDW, H Lower HCT, I PLR, J GGT, K BNP, L V/Cr, M uKIM-1, N Preprocedural hyperglycemia over 140, O Preprocedural hyperglycemia over 200, P Cystatin-C, Q NGAL

Fig. 5

Results of power analysis of the biomarkers. A Hypoalbuminemia, B Hyperuricemia, C BUN, D CRP, E hs-CRP, F NLR, G RDW, H Lower HCT, I PLR, J GGT, K BNP, L V/Cr, M uKIM-1, N Preprocedural hyperglycemia over 140, O Preprocedural hyperglycemia over 200, P Cystatin-C, Q NGAL

Fig. 6

Biomarkers for prediction of contrast-induced nephropathy