This NIHR Evidence Synthesis Programme-funded project aimed at assessing the role of biomarkers for assessing acute kidney injury in critically ill patients who were considered for admission to critical care. Acute kidney injury is a serious complication that occurs in the context of an acute critical illness or during a postoperative period. Earlier detection of acute kidney injury may facilitate strategies to preserve renal function, prevent further disease progression and reduce mortality. Novel biomarkers used in conjunction with existing clinical assessment may enable earlier identification of acute kidney injury and enhance management of those with a modifiable disease course. We conducted a systematic review and meta-analysis to evaluate the performance of novel biomarkers for the detection of acute kidney injury and prediction of other relevant clinical outcomes. Random-effects models were adopted to combine evidence. We searched major electronic databases to identify relevant studies in the literature. We considered evidence from 56 studies (mainly prospective cohort studies) with a total of 17,967 participants. Meta-analysis results showed the potential ability of these biomarkers to detect and predict acute kidney injury; however, there were limited data to establish any causal link with longer-term health outcomes and there were considerable clinical differences across studies. There was insufficient data to determine whether these biomarkers provide cost-effective improvements in the clinical outcomes of acute kidney injury patients. Further research was recommended to evaluate the targeted use of biomarkers among specific patient populations and the clinical impact of their routine use on patient outcomes and management.

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Miriam Brazzelli;