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Proenkephalin as a biomarker correlates with acute kidney injury: a systematic review with meta-analysis and trial sequential analysis

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posted on 2024-01-31, 09:46 authored by LC Lin, MH Chuan, JH Liu, HW Liao, LL Ng, M Magnusson, A Jujic, HC Pan, VC Wu, LG Forni
Background: Proenkephalin A 119-159 (PENK) is freely filtered in the glomerulus with plasma levels correlating with glomerular filtration rate. Therefore, PENK has been proposed as an early indicator of acute kidney injury (AKI) although its performance is dependent on the clinical setting. This meta-analysis aimed to investigate the correlation between PENK levels and the development of AKI. Methods: We conducted a comprehensive search on the PubMed, Embase, Cochrane databases, the website ClinicalTrials.gov and Cnki.net until June 26, 2023. Summary receiver operating characteristic (SROC) curves were used to amalgamate the overall test performance. Diagnostic odds ratio (DOR) was employed to compare the diagnostic accuracy of PENK with other biomarkers. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. Results: We incorporated 11 observational studies with 3969 patients with an incidence of AKI of 23.4% (929 out of 3969 patients) with the best optimal cutoff value of PENK for early detection of AKI being 57.3 pmol/L. The overall sensitivity and specificity of PENK in identifying AKI were 0.69 (95% CI 0.62–0.75) and 0.76 (95% CI 0.68–0.82), respectively. The combined positive likelihood ratio (LR) stood at 2.83 (95% CI 2.06–3.88), and the negative LR was 0.41 (95% CI 0.33–0.52). The SROC curve showcased pooled diagnostic accuracy of 0.77 (95% CI 0.73–0.81). Interestingly, patients with a history of hypertension or heart failure demonstrated a lower specificity of PENK in correlating the development of AKI. Conclusion: Our results indicate that PENK possesses significant potential as a biomarker for the early detection of the development of AKI, using a cutoff point of 57.3 pmol/L for PENK.

Funding

Taiwan National Science Council 104-2314-B-002-125-MY3

Taiwan National Science Council 106-2314-B-002-166-MY3

Taiwan National Science Council 107-2314-B-002-026-MY3

National Taiwan University Hospital 106-FTN20

National Taiwan University Hospital 106-P02

National Taiwan University Hospital UN106-014

National Taiwan University Hospital 106-S3582

National Taiwan University Hospital 107-S3809

National Taiwan University Hospital 107-T02

National Taiwan University Hospital PC1246

National Taiwan University Hospital VN109-09

National Taiwan University Hospital 109-S4634

National Taiwan University Hospital UN109-041

MOST 106-2321-B-182-002

MOST 107-2321-B-182-004

MOST 108-2321-B-182-003

MOST 109-2321-B-182-001

National Health Research Institutes PH-102-SP-09

History

Citation

Lin, LC., Chuan, MH., Liu, JH. et al. Proenkephalin as a biomarker correlates with acute kidney injury: a systematic review with meta-analysis and trial sequential analysis. Crit Care 27, 481 (2023). https://doi.org/10.1186/s13054-023-04747-5

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  • VoR (Version of Record)

Published in

Critical Care

Volume

27

Issue

1

Pagination

481

Publisher

Springer Science and Business Media LLC

issn

1364-8535

eissn

1466-609X

Acceptance date

2023-11-18

Copyright date

2023

Available date

2024-01-31

Spatial coverage

England

Language

eng

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