Diagnostic accuracy of serum cystatin C for pediatric acute kidney injury: a systematic review and meta-analysis.
Mohammed Alsabri, Mohamed Amr Elkarargy, Amira A Aboali et al.
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In 30 seconds
This systematic review and meta-analysis assessed serum cystatin C for diagnosing acute kidney injury in children, using studies that compared it with standardized AKI definitions. Across 26 studies involving 3742 pediatric patients, pooled sensitivity was 78.2% (95% CI 72.6-82.9) and specificity was 79.5% (95% CI 73.5-84.5); the area under the curve was 0.854. Accuracy was higher in ward-based studies than in pediatric intensive care unit cohorts. The authors report moderate certainty for sensitivity and specificity and high certainty for the area under the curve.
Key findings
- Pooled sensitivity was 78.2% (95% CI 72.6-82.9) and specificity was 79.5% (95% CI 73.5-84.5).
- The area under the curve was 0.854, indicating good overall discriminatory performance.
- At 10% prevalence, negative predictive value was 97.0%; at 40% prevalence, positive predictive value was 71.8%.
- Accuracy was higher in ward-based studies than in pediatric intensive care unit cohorts.
Why it matters
Timely recognition of pediatric AKI is challenging because serum creatinine may rise late and have limited sensitivity. These pooled results suggest cystatin C can help identify children with AKI, with predictive values that depend on disease prevalence and accuracy that varies by clinical setting. The findings support considering the biomarker as part of diagnostic assessment while recognizing that performance is not uniform.
What to keep in mind
Accuracy varied by clinical setting, and the authors identify standardized cut-offs and cost-effectiveness evaluation as outstanding needs.