Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data
Purpose We conducted a systematic review and individual patient data (IPD) meta-analysis to examine the utility of cystatin C for evaluation of glomerular function in children with cancer. Methods Eligible studies evaluated the accuracy of cystatin C for detecting poor renal function in children und...
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| creator | Whiting, Penny Birnie, Kate Sterne, Jonathan A. C. Jameson, Catherine Skinner, Rod Phillips, Bob |
| description | Purpose
We conducted a systematic review and individual patient data (IPD) meta-analysis to examine the utility of cystatin C for evaluation of glomerular function in children with cancer.
Methods
Eligible studies evaluated the accuracy of cystatin C for detecting poor renal function in children undergoing chemotherapy. Study quality was assessed using QUADAS-2. Authors of four studies shared IPD. We calculated the correlation between log cystatin C and GFR stratified by study and measure of cystatin C. We dichotomized the reference standard at GFR 80 ml/min/1.73m
2
and stratified cystatin C at 1 mg/l, to calculate sensitivity and specificity in each study and according to age group (0–4, 5–12, and ≥ 13 years). In sensitivity analyses, we investigated different GFR and cystatin C cut points. We used logistic regression to estimate the association of impaired renal function with log cystatin C and quantified diagnostic accuracy using the area under the ROC curve (AUC).
Results
Six studies, which used different test and reference standard thresholds, suggested that cystatin C has the potential to monitor renal function in children undergoing chemotherapy for malignancy. IPD data (504 samples, 209 children) showed that cystatin C has poor sensitivity (63%) and moderate specificity (89%), although use of a GFR cut point of |
| doi_str_mv | 10.1007/s00520-017-4002-3 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_journals_1972873511</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A533934585</galeid><sourcerecordid>A533934585</sourcerecordid><originalsourceid>FETCH-LOGICAL-c482t-d6d6d95c472046c69c6acd1d17bfd8f4856a7c61bae3de2a527cece647a89a13</originalsourceid><addsrcrecordid>eNp1UduKFDEQDaK44-oH-CIBn3vNtdPt2zB4gwVf9j1kkureLNPJmHSvzCf5l9bYq6ygBBKoc6lUHUJec3bFGTPvKmNasIZx0yjGRCOfkA1XUjZGyv4p2bBe8UZJrS_Ii1rvGBKNFs_JhegF6zvZbsiPrfdLcf5E80D9qc5ujonu6JALnW-BBpjBzzGnM-72KZfJHWiBhPewpBVChb-Nh4BluqQAZcwxjViDKaNJccfTL0OUxjG55E_vqaMVu8GE_Tz63Uf4Tpd6lsUU4n0MC3Y4IgpppsHN7iV5NrhDhVcP7yW5-fjhZve5uf766ctue9141Ym5CS2eXntlBFOtb3vfOh944GY_hG5QnW6d8S3fO5ABhNPCePDQKuO63nF5Sd6utseSvy1QZ3uXl4LjVst7IzojNX_EGt0BbExDnnGJU6zebjUuXyrdaWRd_YOFJ8AUfU4wRKz_JeCrwJdca4HBHkucXDlZzuw5crtGbjFJe47cStS8efjwsp8g_FH8zhgJYiVUhNII5dFE_3X9CXCSuXE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1972873511</pqid></control><display><type>article</type><title>Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Whiting, Penny ; Birnie, Kate ; Sterne, Jonathan A. C. ; Jameson, Catherine ; Skinner, Rod ; Phillips, Bob</creator><creatorcontrib>Whiting, Penny ; Birnie, Kate ; Sterne, Jonathan A. C. ; Jameson, Catherine ; Skinner, Rod ; Phillips, Bob ; Cystatin C in Childhood Cancer Collaboration Group ; the Cystatin C in Childhood Cancer Collaboration Group</creatorcontrib><description>Purpose
We conducted a systematic review and individual patient data (IPD) meta-analysis to examine the utility of cystatin C for evaluation of glomerular function in children with cancer.
Methods
Eligible studies evaluated the accuracy of cystatin C for detecting poor renal function in children undergoing chemotherapy. Study quality was assessed using QUADAS-2. Authors of four studies shared IPD. We calculated the correlation between log cystatin C and GFR stratified by study and measure of cystatin C. We dichotomized the reference standard at GFR 80 ml/min/1.73m
2
and stratified cystatin C at 1 mg/l, to calculate sensitivity and specificity in each study and according to age group (0–4, 5–12, and ≥ 13 years). In sensitivity analyses, we investigated different GFR and cystatin C cut points. We used logistic regression to estimate the association of impaired renal function with log cystatin C and quantified diagnostic accuracy using the area under the ROC curve (AUC).
Results
Six studies, which used different test and reference standard thresholds, suggested that cystatin C has the potential to monitor renal function in children undergoing chemotherapy for malignancy. IPD data (504 samples, 209 children) showed that cystatin C has poor sensitivity (63%) and moderate specificity (89%), although use of a GFR cut point of < 60 ml/min/1.73m
2
(data only available from two of the studies) estimated sensitivity to be 92% and specificity 81.3%. The AUC for the combined data set was 0.890 (95% CI 0.826, 0.951). Diagnostic accuracy appeared to decrease with age.
Conclusions
Cystatin C has better diagnostic accuracy than creatinine as a test for glomerular dysfunction in young people undergoing treatment for cancer. Diagnostic accuracy is not sufficient for it to replace current reference standards for predicting clinically relevant impairments that may alter dosing of important nephrotoxic agents.</description><identifier>ISSN: 0941-4355</identifier><identifier>EISSN: 1433-7339</identifier><identifier>DOI: 10.1007/s00520-017-4002-3</identifier><identifier>PMID: 29209836</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Accuracy ; Adolescent ; Analysis ; Cancer ; Chemotherapy ; Child ; Children ; Cystatin C - metabolism ; Data analysis ; Evidence-based medicine ; Female ; Humans ; Kidneys ; Male ; Medical diagnosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasms - complications ; Neoplasms - drug therapy ; Nursing ; Nursing Research ; Oncology ; Original Article ; Pain Medicine ; Patients ; Qualitative Research ; Rehabilitation Medicine ; Renal Insufficiency - diagnosis ; Renal Insufficiency - etiology ; Renal Insufficiency - pathology ; Systematic review</subject><ispartof>Supportive care in cancer, 2018-05, Vol.26 (5), p.1635-1644</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2017</rights><rights>COPYRIGHT 2018 Springer</rights><rights>Supportive Care in Cancer is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c482t-d6d6d95c472046c69c6acd1d17bfd8f4856a7c61bae3de2a527cece647a89a13</citedby><cites>FETCH-LOGICAL-c482t-d6d6d95c472046c69c6acd1d17bfd8f4856a7c61bae3de2a527cece647a89a13</cites><orcidid>0000-0003-1138-5682</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00520-017-4002-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00520-017-4002-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27931,27932,41495,42564,51326</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29209836$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Whiting, Penny</creatorcontrib><creatorcontrib>Birnie, Kate</creatorcontrib><creatorcontrib>Sterne, Jonathan A. C.</creatorcontrib><creatorcontrib>Jameson, Catherine</creatorcontrib><creatorcontrib>Skinner, Rod</creatorcontrib><creatorcontrib>Phillips, Bob</creatorcontrib><creatorcontrib>Cystatin C in Childhood Cancer Collaboration Group</creatorcontrib><creatorcontrib>the Cystatin C in Childhood Cancer Collaboration Group</creatorcontrib><title>Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data</title><title>Supportive care in cancer</title><addtitle>Support Care Cancer</addtitle><addtitle>Support Care Cancer</addtitle><description>Purpose
We conducted a systematic review and individual patient data (IPD) meta-analysis to examine the utility of cystatin C for evaluation of glomerular function in children with cancer.
Methods
Eligible studies evaluated the accuracy of cystatin C for detecting poor renal function in children undergoing chemotherapy. Study quality was assessed using QUADAS-2. Authors of four studies shared IPD. We calculated the correlation between log cystatin C and GFR stratified by study and measure of cystatin C. We dichotomized the reference standard at GFR 80 ml/min/1.73m
2
and stratified cystatin C at 1 mg/l, to calculate sensitivity and specificity in each study and according to age group (0–4, 5–12, and ≥ 13 years). In sensitivity analyses, we investigated different GFR and cystatin C cut points. We used logistic regression to estimate the association of impaired renal function with log cystatin C and quantified diagnostic accuracy using the area under the ROC curve (AUC).
Results
Six studies, which used different test and reference standard thresholds, suggested that cystatin C has the potential to monitor renal function in children undergoing chemotherapy for malignancy. IPD data (504 samples, 209 children) showed that cystatin C has poor sensitivity (63%) and moderate specificity (89%), although use of a GFR cut point of < 60 ml/min/1.73m
2
(data only available from two of the studies) estimated sensitivity to be 92% and specificity 81.3%. The AUC for the combined data set was 0.890 (95% CI 0.826, 0.951). Diagnostic accuracy appeared to decrease with age.
Conclusions
Cystatin C has better diagnostic accuracy than creatinine as a test for glomerular dysfunction in young people undergoing treatment for cancer. Diagnostic accuracy is not sufficient for it to replace current reference standards for predicting clinically relevant impairments that may alter dosing of important nephrotoxic agents.</description><subject>Accuracy</subject><subject>Adolescent</subject><subject>Analysis</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Child</subject><subject>Children</subject><subject>Cystatin C - metabolism</subject><subject>Data analysis</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - drug therapy</subject><subject>Nursing</subject><subject>Nursing Research</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Qualitative Research</subject><subject>Rehabilitation Medicine</subject><subject>Renal Insufficiency - diagnosis</subject><subject>Renal Insufficiency - etiology</subject><subject>Renal Insufficiency - pathology</subject><subject>Systematic review</subject><issn>0941-4355</issn><issn>1433-7339</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1UduKFDEQDaK44-oH-CIBn3vNtdPt2zB4gwVf9j1kkureLNPJmHSvzCf5l9bYq6ygBBKoc6lUHUJec3bFGTPvKmNasIZx0yjGRCOfkA1XUjZGyv4p2bBe8UZJrS_Ii1rvGBKNFs_JhegF6zvZbsiPrfdLcf5E80D9qc5ujonu6JALnW-BBpjBzzGnM-72KZfJHWiBhPewpBVChb-Nh4BluqQAZcwxjViDKaNJccfTL0OUxjG55E_vqaMVu8GE_Tz63Uf4Tpd6lsUU4n0MC3Y4IgpppsHN7iV5NrhDhVcP7yW5-fjhZve5uf766ctue9141Ym5CS2eXntlBFOtb3vfOh944GY_hG5QnW6d8S3fO5ABhNPCePDQKuO63nF5Sd6utseSvy1QZ3uXl4LjVst7IzojNX_EGt0BbExDnnGJU6zebjUuXyrdaWRd_YOFJ8AUfU4wRKz_JeCrwJdca4HBHkucXDlZzuw5crtGbjFJe47cStS8efjwsp8g_FH8zhgJYiVUhNII5dFE_3X9CXCSuXE</recordid><startdate>20180501</startdate><enddate>20180501</enddate><creator>Whiting, Penny</creator><creator>Birnie, Kate</creator><creator>Sterne, Jonathan A. C.</creator><creator>Jameson, Catherine</creator><creator>Skinner, Rod</creator><creator>Phillips, Bob</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88J</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HEHIP</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2R</scope><scope>M2S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><orcidid>https://orcid.org/0000-0003-1138-5682</orcidid></search><sort><creationdate>20180501</creationdate><title>Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data</title><author>Whiting, Penny ; Birnie, Kate ; Sterne, Jonathan A. C. ; Jameson, Catherine ; Skinner, Rod ; Phillips, Bob</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c482t-d6d6d95c472046c69c6acd1d17bfd8f4856a7c61bae3de2a527cece647a89a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Accuracy</topic><topic>Adolescent</topic><topic>Analysis</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Child</topic><topic>Children</topic><topic>Cystatin C - metabolism</topic><topic>Data analysis</topic><topic>Evidence-based medicine</topic><topic>Female</topic><topic>Humans</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - drug therapy</topic><topic>Nursing</topic><topic>Nursing Research</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Qualitative Research</topic><topic>Rehabilitation Medicine</topic><topic>Renal Insufficiency - diagnosis</topic><topic>Renal Insufficiency - etiology</topic><topic>Renal Insufficiency - pathology</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Whiting, Penny</creatorcontrib><creatorcontrib>Birnie, Kate</creatorcontrib><creatorcontrib>Sterne, Jonathan A. C.</creatorcontrib><creatorcontrib>Jameson, Catherine</creatorcontrib><creatorcontrib>Skinner, Rod</creatorcontrib><creatorcontrib>Phillips, Bob</creatorcontrib><creatorcontrib>Cystatin C in Childhood Cancer Collaboration Group</creatorcontrib><creatorcontrib>the Cystatin C in Childhood Cancer Collaboration Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Sociology Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Social Science Database</collection><collection>Sociology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>Supportive care in cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Whiting, Penny</au><au>Birnie, Kate</au><au>Sterne, Jonathan A. C.</au><au>Jameson, Catherine</au><au>Skinner, Rod</au><au>Phillips, Bob</au><aucorp>Cystatin C in Childhood Cancer Collaboration Group</aucorp><aucorp>the Cystatin C in Childhood Cancer Collaboration Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data</atitle><jtitle>Supportive care in cancer</jtitle><stitle>Support Care Cancer</stitle><addtitle>Support Care Cancer</addtitle><date>2018-05-01</date><risdate>2018</risdate><volume>26</volume><issue>5</issue><spage>1635</spage><epage>1644</epage><pages>1635-1644</pages><issn>0941-4355</issn><eissn>1433-7339</eissn><abstract>Purpose
We conducted a systematic review and individual patient data (IPD) meta-analysis to examine the utility of cystatin C for evaluation of glomerular function in children with cancer.
Methods
Eligible studies evaluated the accuracy of cystatin C for detecting poor renal function in children undergoing chemotherapy. Study quality was assessed using QUADAS-2. Authors of four studies shared IPD. We calculated the correlation between log cystatin C and GFR stratified by study and measure of cystatin C. We dichotomized the reference standard at GFR 80 ml/min/1.73m
2
and stratified cystatin C at 1 mg/l, to calculate sensitivity and specificity in each study and according to age group (0–4, 5–12, and ≥ 13 years). In sensitivity analyses, we investigated different GFR and cystatin C cut points. We used logistic regression to estimate the association of impaired renal function with log cystatin C and quantified diagnostic accuracy using the area under the ROC curve (AUC).
Results
Six studies, which used different test and reference standard thresholds, suggested that cystatin C has the potential to monitor renal function in children undergoing chemotherapy for malignancy. IPD data (504 samples, 209 children) showed that cystatin C has poor sensitivity (63%) and moderate specificity (89%), although use of a GFR cut point of < 60 ml/min/1.73m
2
(data only available from two of the studies) estimated sensitivity to be 92% and specificity 81.3%. The AUC for the combined data set was 0.890 (95% CI 0.826, 0.951). Diagnostic accuracy appeared to decrease with age.
Conclusions
Cystatin C has better diagnostic accuracy than creatinine as a test for glomerular dysfunction in young people undergoing treatment for cancer. Diagnostic accuracy is not sufficient for it to replace current reference standards for predicting clinically relevant impairments that may alter dosing of important nephrotoxic agents.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29209836</pmid><doi>10.1007/s00520-017-4002-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1138-5682</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Accuracy Adolescent Analysis Cancer Chemotherapy Child Children Cystatin C - metabolism Data analysis Evidence-based medicine Female Humans Kidneys Male Medical diagnosis Medicine Medicine & Public Health Middle Aged Neoplasms - complications Neoplasms - drug therapy Nursing Nursing Research Oncology Original Article Pain Medicine Patients Qualitative Research Rehabilitation Medicine Renal Insufficiency - diagnosis Renal Insufficiency - etiology Renal Insufficiency - pathology Systematic review |
| title | Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data |
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