Methodological issues in current practice may lead to bias in the development of biomarker combinations for predicting acute kidney injury

Allison Meisner, Kathleen F. Kerr, Heather Thiessen-Philbrook, Steven G. Coca, Chirag R. Parikh

Research output: Contribution to journalArticlepeer-review

Abstract

Individual biomarkers of renal injury are only modestly predictive of acute kidney injury (AKI). Using multiple biomarkers has the potential to improve predictive capacity. In this systematic review, statistical methods of articles developing biomarker combinations to predict AKI were assessed. We identified and described three potential sources of bias (resubstitution bias, model selection bias, and bias due to center differences) that may compromise the development of biomarker combinations. Fifteen studies reported developing kidney injury biomarker combinations for the prediction of AKI after cardiac surgery (8 articles), in the intensive care unit (4 articles), or other settings (3 articles). All studies were susceptible to at least one source of bias and did not account for or acknowledge the bias. Inadequate reporting often hindered our assessment of the articles. We then evaluated, when possible (7 articles), the performance of published biomarker combinations in the TRIBE-AKI cardiac surgery cohort. Predictive performance was markedly attenuated in six out of seven cases. Thus, deficiencies in analysis and reporting are avoidable, and care should be taken to provide accurate estimates of risk prediction model performance. Hence, rigorous design, analysis, and reporting of biomarker combination studies are essential to realizing the promise of biomarkers in clinical practice.

Original languageEnglish (US)
Pages (from-to)429-438
Number of pages10
JournalKidney international
Volume89
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Keywords

  • NGAL
  • biomarkers
  • combinations
  • diagnosis
  • methods
  • prognosis

ASJC Scopus subject areas

  • Nephrology

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