Sebastien Ninet1, David Schnell2, Antoine Dewitte3, Fabrice Zeni1, Ferhat Meziani2, Michael Darmon4. 1. Réanimation médico-chirurgicale, Hôpital Nord, avenue Albert Raymond, 42270 St Priest en Jarez, France, Université Jean Monnet, Saint-Etienne, France. 2. Réanimation médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital-BP 426, 67091 Strasbourg Cedex, France. 3. Service d'Anesthésie-Réanimation II, avenue de Magellan, CHU de Bordeaux, F-33604 Pessac, France, Université de Bordeaux, Bioingénierie tissulaire, U1026, 146 rue Léo-Saignat, F-33000 Bordeaux, France. 4. Réanimation médico-chirurgicale, Hôpital Nord, avenue Albert Raymond, 42270 St Priest en Jarez, France, Université Jean Monnet, Saint-Etienne, France; Thrombosis Research Group, EA 3065, Saint-Etienne University Hospital and Saint-Etienne Medical School, Saint-Etienne, France.
Abstract
BACKGROUND AND OBJECTIVES: Doppler-based renal resistive index (RI) might help in distinguishing transient from persistent acute kidney injury (AKI). The main objective of these systematic review and meta-analysis was to investigate the diagnostic performance of RI in predicting short-term reversibility of AKI. STUDY DESIGN: A systematic review of the literature was performed. Relevant studies were identified in Pubmed and Cochrane databases covering the years 1985 to 2013 and reviewed independently by 3 authors. Renal transplant recipients were excluded from this analysis. The summary estimates were computed using a random-effects model based on the DerSimonian and Lair meta-analytic method. RESULTS: Among the 154 unique articles identified, 9 studies were included. Of the 176 patients in these studies with elevated RI or pulsatility index, 146 (83%) had a persistent AKI vs 44 (16%) of the 273 patients with normal values. Elevated RI or pulsatility index was associated with an increased risk of persistent AKI (odds ratio, 29.85; 95% confidence interval [CI], 8.73-102.16; P < .00001) with significant heterogeneity (I(2) = 75.0%, P < .0001). The pooled sensitivity and specificity were 0.83 (95% CI, 0.77-0.88) and 0.84 (95% CI, 0.79-0.88). The summary positive and negative likelihood ratios were 4.9 (95% CI, 2.44-9.87) and 0.21 (95% CI, 0.11-0.41). CONCLUSION: These results suggest that an elevated RI may be a predictor of persistent AKI in critically ill patients. Further studies are warranted, however, to clarify the exact test performance given the marked heterogeneity among the included studies.
BACKGROUND AND OBJECTIVES: Doppler-based renal resistive index (RI) might help in distinguishing transient from persistent acute kidney injury (AKI). The main objective of these systematic review and meta-analysis was to investigate the diagnostic performance of RI in predicting short-term reversibility of AKI. STUDY DESIGN: A systematic review of the literature was performed. Relevant studies were identified in Pubmed and Cochrane databases covering the years 1985 to 2013 and reviewed independently by 3 authors. Renal transplant recipients were excluded from this analysis. The summary estimates were computed using a random-effects model based on the DerSimonian and Lair meta-analytic method. RESULTS: Among the 154 unique articles identified, 9 studies were included. Of the 176 patients in these studies with elevated RI or pulsatility index, 146 (83%) had a persistent AKI vs 44 (16%) of the 273 patients with normal values. Elevated RI or pulsatility index was associated with an increased risk of persistent AKI (odds ratio, 29.85; 95% confidence interval [CI], 8.73-102.16; P < .00001) with significant heterogeneity (I(2) = 75.0%, P < .0001). The pooled sensitivity and specificity were 0.83 (95% CI, 0.77-0.88) and 0.84 (95% CI, 0.79-0.88). The summary positive and negative likelihood ratios were 4.9 (95% CI, 2.44-9.87) and 0.21 (95% CI, 0.11-0.41). CONCLUSION: These results suggest that an elevated RI may be a predictor of persistent AKI in critically illpatients. Further studies are warranted, however, to clarify the exact test performance given the marked heterogeneity among the included studies.
Authors: Michael Darmon; Aurelie Bourmaud; Marie Reynaud; Stéphane Rouleau; Ferhat Meziani; Alexandra Boivin; Mourad Benyamina; François Vincent; Alexandre Lautrette; Christophe Leroy; Yves Cohen; Matthieu Legrand; Jérôme Morel; Jeremy Terreaux; David Schnell Journal: Intensive Care Med Date: 2018-10-05 Impact factor: 17.440
Authors: Anne D Cherry; Jennifer N Hauck; Benjamin Y Andrew; Yi-Ju Li; Jamie R Privratsky; Lakshmi D Kartha; Alina Nicoara; Annemarie Thompson; Joseph P Mathew; Mark Stafford-Smith Journal: J Clin Anesth Date: 2019-11-04 Impact factor: 9.452