Association of high-sensitivity C-reactive protein and anemia with acute kidney injury in neonates

Risk factors and mortality of postoperative acute kidney injury (AKI) in newborns across geographical regions, surgical type, and national economic levels: a systematic review and meta-analysis

BACKGROUND

It is noted that postoperative acute kidney injury (AKI) in neonates is known to be associated with adverse outcomes, yet its incidence and risk factors remain incompletely elucidated. The current study aims to improve the understanding of postoperative AKI in neonates by systematically evaluating its incidence, diagnostic criteria, risk factors, and clinical outcomes, with particular attention to variations across geographic regions, surgical types, the span of time, and national economic statuses.

METHODS

A comprehensive search of Pubmed, Embase, OVID, Web of Science (WOS), Medline, and Cochrane Controlled Register of Trials (CENTRAL) was conducted from inception to 30 September 2024. Studies meeting all the following inclusion criteria were enrolled: 1) Population: neonates aged ≤ 30 days; 2) Disease: postoperative AKI diagnosed per KDIGO, pRIFLE, AKIN, nKDIGO, or others; 3) Study design: prospective/retrospective cohort studies or case-control studies; 4) Reporting data on postoperative incidence of AKI. The pooled proportion (along with 95% confidence intervals [CI]) of postoperative AKI was calculated. We also calculated pooled odds ratios (95% CI) for all-cause mortality in neonates with postoperative AKI when compared with those without AKI.

RESULTS

A total of 69 studies (10,519 cases) were included in the meta-analysis. The pooled incidence of postoperative AKI in neonates was 37% (95%CI 32-42, I2 = 96.4%, P<0.01), with a wide variability ranging from 0.0% to 74.8%. Several risk factors were identified, including lower preoperative or intraoperative urinary output, lower preoperative serum creatinine (SCr)/higher maximum postoperative SCr, elevated vasoactive inotrope score (VIS)/hypotension, younger corrected gestational age, prolonged cardiopulmonary bypass (CPB) duration, hypothermia, sepsis, and preoperative ventilation. Furthermore, 28 studies involving 6714 patients reported data on AKI-associated mortality with an overall incidence of 8.2%. Neonates who developed postoperative AKI had 3.3 times higher odds of mortality as compared to those without this complication.

CONCLUSIONS

Postoperative AKI affects one-third of neonates, and AKI-associated mortality remains high. Future efforts should focus on developing earlier and more sensitive detection methods.

SYSTEMATIC REVIEW REGISTRATION NUMBER

This meta-analysis was registered on https://www.crd.york.ac.uk/prospero/ with the registration number CRD 42024602820 on October 29, 2024.

An overview of circulating and urinary biomarkers capable of predicting the transition of acute kidney injury to chronic kidney disease

INTRODUCTION

Acute kidney injury (AKI) defined by a substantial decrease in kidney function within hours to days and is often irreversible with higher risk to chronic kidney disease (CKD) transition.

AREAS COVERED

The authors discuss the diagnostic and predictive utilities of serum and urinary biomarkers on AKI and on the risk of AKI-to-CKD progression. The authors focus on the relevant literature covering evidence of circulating and urinary biomarkers' capability to predict the transition of AKI to CKD.

EXPERT OPINION

Based on the different modalities of serum and urinary biomarkers, multiple biomarker panel seems to be potentially useful to distinguish between various types of AKI, to detect the severity and the risk of AKI progression, to predict the clinical outcome and evaluate response to the therapy. Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary uromodulin, serum extracellular high mobility group box-1 (HMGB-1), serum cystatin C and urinary liver-type fatty acid-binding protein (L-FABP) were the most effective in the prediction of AKI-to-CKD transition regardless of etiology and the presence of critical state in patients. The current clinical evidence on the risk assessments of AKI progression is mainly based on the utility of combination of functional, injury and stress biomarkers, mainly NGAL, L-FABP, HMGB-1 and cystatin C.

A Retrospective Analysis of the Association of Neutrophil-Lymphocyte Ratio (NLR) with Anemia in the Saudi Population

Background: The link between inflammation and anemia is well established but fluctuations in the emerging inflammatory index, neutrophil-lymphocyte ratio (NLR), in anemic subjects remain ambiguous. The purpose of this study is to address the prevailing knowledge gaps regarding the association of NLR with anemia in the Saudi population. Methods: Laboratory results of NLR, C-reactive protein (CRP), and hemoglobin for 14,261 subjects were obtained from Al Borg Diagnostics and retrospectively analyzed. Means, risk measures, and the diagnostic performance of NLR for anemia were examined in age- and gender-wise comparisons. Results: NLR was significantly elevated in anemic individuals and those with high NLR had a significantly lower Hb concentration. Moreover, elevated NLR was more prevalent in anemic subjects (PR: 1.87, 95% CI: 1.46-2.40, p < 0.0001) and carried a greater risk for the condition (OR: 1.91, 95% CI: 1.47-2.48, p < 0.0001) as did CRP. These observations demonstrated distinct age- and gender-specific patterns. However, both parameters were of no value in the diagnosis of anemia as seen from receiver operating characteristic curves. Conclusions: Altogether, these findings indicate that elevated NLR is associated with anemia, which suggests its usefulness for monitoring rather than diagnosing anemia associated with inflammation in Saudi subjects. Further examination of this association in longitudinal studies is needed.

Neonatal AKI: An update

Neonatal acute kidney injury (AKI) is a common complication, especially in the neonatal intensive care unit, that is associated with long term consequences and poor outcomes. Early detection and treatment is critical. Currently, neonatal AKI is defined with urinary markers and serum creatinine, with limitations on early detection and individual treatment. There have been numerous biomarkers and risk factor scores that have been studied for their ability to predict neonatal AKI. To move towards personalized medicine, neonatal AKI must be categorized into phenotypes and subphenotypes that fully encapsulate the diverse causes and specific treatments. This review aims to advance our understanding of neonatal AKI detection through the use of biomarkers, subphenotypes, and phenotypes to move towards personalized treatment strategies.