• Yawei Liu, Wenyuan Guo, Jiayou Zhang, Chenggang Xu, Shengqiang Yu, Zhiguo Mao, Jun Wu, Chaoyang Ye, Changlin Mei, and Bing Dai.
• Division of Nephrology, Nephrology Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
• Am. J. Kidney Dis. 2013 Dec 1;62(6):1058-67.

BackgroundInterleukin 18 (IL-18) has been proposed as a biomarker for the early detection of acute kidney injury (AKI), but a broad range of its predictive accuracy has been reported.Study DesignMeta-analysis of diagnostic test studies.Setting & PopulationVarious clinical settings of AKI, including after cardiac surgery, after contrast infusion, in the emergency department, or in the intensive care unit.Selection Criteria For StudiesProspective studies that investigated the diagnostic accuracy of IL-18 level to predict AKI.Index TestsIncreasing or increased urinary IL-18 excretion.Reference TestsThe primary outcome was AKI development, mainly based on serum creatinine level (definition varied across studies). The other outcome was in-hospital mortality.ResultsWe analyzed data from 23 studies and 7 countries involving 4,512 patients. Of these studies, 18 could be included in the meta-analysis. Across all settings, the diagnostic odds ratio (DOR) for urinary IL-18 level to predict AKI was 4.22 (95% CI, 2.90-6.14), with sensitivity and specificity of 0.58 and 0.75, respectively. The area under the receiver operating characteristic curve (AUROC) of urinary IL-18 level to predict AKI was 0.70 (95% CI, 0.66-0.74). Subgroup analysis showed the DOR/AUROC of urinary IL-18 was 5.32 (95% CI, 2.92-9.70)/0.72 (95% CI, 0.68-0.76) in cardiac surgery patients and 3.65 (95% CI, 1.88-7.10)/0.66 (95% CI, 0.62-0.70) in intensive care unit or coronary care unit patients. After stratification for age, IL-18 level had better diagnostic accuracy in children and adolescents versus adults: 8.12 (95% CI, 3.79-17.41)/0.78 (95% CI, 0.75-0.82) versus 3.31 (95% CI, 2.28-4.80)/0.66 (95% CI, 0.62-0.70). There was no significant difference in predictive performance of urinary IL-18 level among various times.LimitationsVarious clinical settings; different definition of AKI and serum creatinine level as the reference standard test for the diagnosis of AKI.ConclusionsUrinary IL-18 is a useful biomarker of AKI with moderate predictive value across all clinical settings.Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

24 keywords...

hide…