Assessing the value of serum and urinary interleukins for diagnosis of acute kidney injury in children and adolescents: A systematic review and meta-analysis

Abstract

Introduction Several studies have questioned the diagnostic utility of interleukins (IL) in detecting acute kidney injury (AKI) in pediatric population. Therefore, the present systematic review and meta-analysis aims to assess the diagnostic value of ILs in pediatric AKI patients. Method Two independent researchers screened records acquired through searching in Medline, Embase, Scopus, and Web of Science, until the end of 2020. Articles evaluating serum and urinary levels of ILs in AKI patients were included in this study. Data were extracted and analyzed using STATA software. Results Twenty-one studies were included. Analyses showed that AUC, sensitivity, specificity and diagnostic odds ratio of urinary IL-18 for diagnosing AKI were 0.77 (95% CI: 0.74, 0.81), 0.64 (95% CI: 0.32, 0.87), 0.75 (95% CI: 0.62, 0.85) and 6 (95% CI: 1, 23), respectively. Those values were 0.79 (95% CI: 0.75, 0.83), 0.58 (95% CI: 0.37, 0.76), 0.87 (95% CI: 0.66, 0.96), and 9 (95% CI: 4, 20) for serum IL-6, and 0.72 (95% CI: 0.68, 0.76), 0.53 (95% CI: 0.34, 0.72), 0.79 (95% CI: 0.60, 0.91) and 4 (95% CI: 2, 8) for serum IL-8, respectively. Urinary levels of ILs 6, 8 and 10 were not significantly different between AKI patients and the non-AKI control group. Serum levels of ILs 10 and 18 were not adequately evaluated in the studies. Conclusion IL-18 urinary levels and IL-6 and IL-8 serum levels are significantly higher in AKI patients compared to the non-AKI group. However, their low sensitivity and specificity in detecting AKI questions their diagnostic value.

Disaster of the Century, 2023 Earthquake of Turkey: How Can We Prevent Amputation of Children

“…In our study, this elevation was detected in 205 patients, and in line with the literature, the development of crush syndrome and the need for fasciotomy were found to be signi cantly higher in these patients. In a study investigating the prevalence of post-traumatic acute kidney injury (AKI) in children victims, the prevalence was found to be 24.6% (51). In our study, the elevation of BUN and Creatin was detected in 81 of the patients, and crush syndrome and the need for fasciotomy were signi cant in these patients.…”

Nationwide Analysis of Biomechanics of Motor Vehicle Collisions Involving Passenger Vehicle and Associated Outcomes: Towards Improving Vehicle Safety Standards and Regulations

“…Previous studies have demonstrated that seatbelt use is a protective factor against mortality and serious injury which is consistent with the lower MAIS and mortality observed in our study. 15,16 However, the observed higher number of injuries contradicts the literature. 15,16 A possible explanation for the increased number of injuries with seatbelt use is that seatbelts protect occupants from serious injuries by spreading kinetic forces over a greater body surface area, resulting in a greater number of injuries that are less severe.…”

“…15,16 However, the observed higher number of injuries contradicts the literature. 15,16 A possible explanation for the increased number of injuries with seatbelt use is that seatbelts protect occupants from serious injuries by spreading kinetic forces over a greater body surface area, resulting in a greater number of injuries that are less severe. 3…”

Advances in laboratory detection of acute kidney injury

“…In their review, Hasson et al [ 4 ] focus on those markers that are closest to clinical practice and that have already received regulatory approval in the U.S. or Europe. However, other unapproved biomarkers, such as proenkephalin or interleukins 6 (IL-6), IL-8 and IL-18, are also being evaluated for their ability to detect AKI, which is why meta-analyses like the one provided by Yousefifard et al [ 5 ] are essential to understand how well these are performing and if they hold any promise for clinical care. In the case of urinary IL-18 and serum IL-6 and IL-8, their meta-analysis shows that while levels of these markers are higher in AKI patients compared to the control group, their sensitivity and specificity is poor, which questions their diagnostic value [ 5 ].…”

“…However, other unapproved biomarkers, such as proenkephalin or interleukins 6 (IL-6), IL-8 and IL-18, are also being evaluated for their ability to detect AKI, which is why meta-analyses like the one provided by Yousefifard et al [ 5 ] are essential to understand how well these are performing and if they hold any promise for clinical care. In the case of urinary IL-18 and serum IL-6 and IL-8, their meta-analysis shows that while levels of these markers are higher in AKI patients compared to the control group, their sensitivity and specificity is poor, which questions their diagnostic value [ 5 ]. While Lima et al [ 6 ] demonstrated in a small subset of liver transplant patients (n = 57) that proenkephalin may hold promise for greater accuracy and earlier rise than creatinine in patients with severe AKI.…”