J KUO1, L K AKISON1,2, M D CHATFIELD1, P TRNKA1,3, K M MORITZ1,2
1Child Health Research Centre, The University of Queensland, South Brisbane, Australia, 2School of Biomedical Sciences, The University of Queensland, St Lucia, Australia, 3Queensland Child and Adolescent Renal Service, Queensland Children’s Hospital, South Brisbane, Australia
Aim: To conduct a systematic review and meta-analysis to determine the diagnostic accuracy of urine and serum biomarkers to predict acute kidney injury (AKI) in premature infants.
Background: AKI is estimated to affect up to 40% of premature infants worldwide. Premature infants have immature kidneys which makes them particularly vulnerable to AKI events. Several issues exist with current AKI criteria using serum creatinine. Therefore, there is a significant clinical need for a urine or serum biomarker that can effectively diagnose AKI early in premature infants.
Methods: This systematic review and meta-analysis adhered to PRISMA guidelines. Research publications were identified by systematically searching in PubMed, EMBASE, CINAHL, Scopus and Cochrane Library databases from inception until October 2019. The search strategy included MeSH and key terms synonymous with infant, AKI and biomarkers. Identified articles were reviewed against pre-defined inclusion/exclusion criterion.
Results: Fourteen studies were eligible for inclusion. Biomarkers identified were urinary neutrophil gelatinase-association lipocalin (uNGAL), osteopontin, epidermal growth factor, uromodulin, cystatin C, tissue inhibitor of metalloproteinases-2 and insulin-like growth factor binding protein 7, hippurate and homovanillate, and serum cystatin C. A meta-analysis could only be conducted on uNGAL which included 260 premature infants from 5 studies. uNGAL had a summary sensitivity of 75% (95% CI, 36%–94%), specificity of 82% (95% CI, 65%–91%), area under the curve for the summary receiver-operating characteristic (AUC-SROC) of 0.86, and diagnostic odds ratio (DOR) of 13.68 (95% CI, 3.54–52.81) for the diagnosis of AKI.
Conclusions: Several biomarkers appear to be of significant diagnostic value and should be further validated in larger studies. In particular, uNGAL has a very good diagnostic accuracy for AKI in premature infants.
Jenny Kuo is a concurrent Doctor of Medicine and Master of Philosophy student at the University of Queensland. She has been heavily involved in various research projects since her undergraduate studies. Currently, her research endeavours centre around premature infants and acute kidney injury under the supervision of Professor Karen Moritz and Associate Professor Peter Trnka at the Child Health Research Centre. She plans to continue to be involved in translational research in conjunction with her medical career as a future clinician scientist.