title: Urine interleukin-18 in prediction of acute kidney injury: a systemic review and meta-analysis.
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.
  
  
  CONCLUSIONS
  Urine IL-18 holds promise as a biomarker in the prediction of AKI but has only moderate diagnostic value.
authors.affiliation: Department of Nephrology, People's Hospital of Guizhou Province, No. 83, Zhongshan East Road, Guiyang, 550002, Guizhou, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Lin
authors.forename: Jing
authors.initials: J
authors.lastname: Yuan
authors.forename: Yingting
authors.initials: Y
authors.lastname: Zhao
authors.forename: Yan
authors.initials: Y
authors.lastname: Zha
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D000367:Age Factors; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000097:blood; D006801:Humans; D020382:Interleukin-18 / Q000652:urine*; D011237:Predictive Value of Tests; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D020382:Interleukin-18; D003404:Creatinine