The following is a summary of “Proenkephalin as a biomarker correlates with acute kidney injury: a systematic review with meta-analysis and trial sequential analysis,” published in the December 2023 issue of Critical Care by Lin et al.
Proenkephalin A 119-159 (PENK) levels, freely reflecting glomerular filtration rate (GFR), suggest its potential as an early marker for acute kidney injury (AKI). However, its performance varies depending on the clinical context. Researchers conducted a retrospective study to systematically assess the association between PENK levels and the development of AKI.
They searched PubMed, Embase, Cochrane, ClinicalTrials.gov, and Cnki.net (June 26, 2023) to analyze the accuracy of PENK levels in predicting AKI. Summary receiver operating characteristic (SROC) curves and diagnostic odds ratio (DOR) were used to evaluate and compare PENK’s diagnostic performance with other biomarkers. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria assessed the quality of the evidence.
The results showed 11 observational studies involving 3,969 patients, with an AKI incidence of 23.4% (929/3969 patients). The optimal cutoff value for early AKI detection using PENK was 57.3 pmol/L. PENK demonstrated an overall sensitivity of 0.69 (95% CI 0.62–0.75) and a specificity of 0.76 (95% CI 0.68–0.82). The combined positive likelihood ratio (LR) was 2.83 (95% CI 2.06–3.88), and the negative LR was 0.41 (95% CI 0.33–0.52). The SROC curve illustrated a pooled diagnostic accuracy 0.77 (95% CI 0.73–0.81). Notably, patients with a history of hypertension or heart failure exhibited a lower specificity of PENK in predicting AKI development.
They concluded that PENK showed substantial promise as a biomarker for early AKI detection, with a 57.3 pmol/L cutoff.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04747-5