Combination of urinary biomarkers can predict cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis.

Summary

Across 95 studies, individual urinary biomarkers measured intraoperatively or early postoperatively showed acceptable discrimination for cardiac surgery–associated AKI. Combining biomarkers improved accuracy, achieving AUCs up to 0.85 for severe AKI, supporting multimarker strategies and integration into clinical prediction models.

Key Findings

• Systematic review/meta-analysis of 95 studies assessing urinary biomarkers for CS-AKI prediction.
• Individual biomarkers measured intraoperatively/early postoperatively showed acceptable AUCs (~0.73–0.75 for all AKI; ~0.74 for severe AKI).
• Combining urinary biomarkers increased discrimination (AUC 0.82 for all AKI; 0.85 for severe AKI).

Clinical Implications

Adopting combined urinary biomarker panels (e.g., integrating complementary pathways) during and after cardiac surgery may allow earlier identification of high-risk patients and timely implementation of renal-protective bundles.

Limitations

• Heterogeneity across biomarker assays, timing, and AKI definitions may affect pooled estimates.
• Diagnostic accuracy studies are subject to spectrum bias and variable reference standards.

Future Directions

Prospective multicenter validation of standardized multimarker panels and integration into dynamic clinical prediction tools to trigger targeted nephroprotection.