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

Xin Lin, Jing Yuan, Yingting Zhao, Yan Zha, Xin Lin, Jing Yuan, Yingting Zhao, Yan Zha

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.

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

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.
    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.
    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.
    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.
    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.
    1. Zheng J, Xiao Y, Yao Y, et al. Comparison of urinary biomarkers for early detection of acute kidney injury after cardiopulmonary bypass surgery in infants and young children. Pediatr Cardiol. 2013;34(4):880–886. doi: 10.1007/s00246-012-0563-6.
    1. Sirota JC, Walcher A, Faubel S, et al. Urine IL-18, NGAL, IL-8 and serum IL-8 are biomarkers of acute kidney injury following liver transplantation. BMC Nephrol. 2013;14:17. doi: 10.1186/1471-2369-14-17.
    1. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–2012. doi: 10.1001/jama.283.15.2008.
    1. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–536. doi: 10.7326/0003-4819-155-8-201110180-00009.
    1. Rosman AS, Korsten MA. Application of summary receiver operating characteristics (sROC) analysis to diagnostic clinical testing. Adv Med Sci. 2007;52:76–82.
    1. Li Y, Fu C, Zhou X, et al. Urine interleukin-18 and cystatin-C as biomarkers of acute kidney injury in critically ill neonates. Pediatr Nephrol. 2012;27(5):851–860. doi: 10.1007/s00467-011-2072-x.
    1. Chen TH, Chang CH, Lin CY, et al. Acute kidney injury biomarkers for patients in a coronary care unit: a prospective cohort study. PLoS ONE. 2012;7(2):e32328. doi: 10.1371/journal.pone.0032328.
    1. Parikh CR, Devarajan P, Zappitelli M, et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery. J Am Soc Nephrol. 2011;22(9):1737–1747. doi: 10.1681/ASN.2010111163.
    1. Parikh CR, Coca SG, Thiessen-Philbrook H, et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol. 2011;22(9):1748–1757. doi: 10.1681/ASN.2010121302.
    1. Endre ZH, Pickering JW, Walker RJ, et al. Improved performance of urinary biomarkers of acute kidney injury in the critically ill by stratification for injury duration and baseline renal function. Kidney Int. 2011;79(10):1119–1130. doi: 10.1038/ki.2010.555.
    1. Liangos O, Tighiouart H, Perianayagam MC, et al. Comparative analysis of urinary biomarkers for early detection of acute kidney injury following cardiopulmonary bypass. Biomarkers. 2009;14(6):423–431. doi: 10.1080/13547500903067744.
    1. Washburn KK, Zappitelli M, Arikan AA, et al. Urinary interleukin-18 is an acute kidney injury biomarker in critically ill children. Nephrol Dial Transplant. 2008;23(2):566–572. doi: 10.1093/ndt/gfm638.
    1. Parikh CR, Mishra J, Thiessen-Philbrook H, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70(1):199–203. doi: 10.1038/sj.ki.5001527.
    1. Parikh CR, Abraham E, Ancukiewicz M, Edelstein CL. Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit. J Am Soc Nephrol. 2005;16(10):3046–3052. doi: 10.1681/ASN.2005030236.
    1. Lau J, Ioannidis JP, Schmid CH. Quantitative synthesis in systematic reviews. Ann Intern Med. 1997;127(9):820–826. doi: 10.7326/0003-4819-127-9-199711010-00008.
    1. Zelenina M, Li Y, Glorieux I, et al. Urinary aquaporin-2 excretion during early human development. Pediatr Nephrol. 2006;21(7):947–952. doi: 10.1007/s00467-006-0143-1.
    1. Nash MA, Edelmann JRCM. The developing kidney. Nephron. 1973;11(2–4):71–90. doi: 10.1159/000180221.
    1. Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002;40(2):221–226. doi: 10.1053/ajkd.2002.34487.
    1. Parikh CR, Jani A, Melnikov VY, et al. Urinary interleukin-18 is a marker of human acute tubular necrosis. Am J Kidney Dis. 2004;43(3):405–414. doi: 10.1053/j.ajkd.2003.10.040.
    1. Melnikov VY, Faubel S, Siegmund B, et al. Neutrophil-independent mechanisms of caspase-1- and IL-18-mediated ischemic acute tubular necrosis in mice. J Clin Investig. 2002;110(8):1083–1091. doi: 10.1172/JCI0215623.
    1. Tschoeke SK, Oberholzer A, Moldawer LL. Interleukin-18: a novel prognostic cytokine in bacteria-induced sepsis. Crit Care Med. 2006;34(4):1225–1233. doi: 10.1097/01.CCM.0000208356.05575.16.

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