J Rheum Dis.  2017 Apr;24(2):85-92. 10.4078/jrd.2017.24.2.85.

Urinary Tumor Necrosis Factor-like Weak Inducer of Apoptosis as a Biomarker for Lupus Nephritis: A Meta-analysis

• Lee YH
• Song GG

• KMID: 2378086
• DOI: http://doi.org/10.4078/jrd.2017.24.2.85

Abstract

OBJECTIVE
This study evaluates serum or urinary tumor necrosis factor-like weak inducer of apoptosis (TWEAK) as a biomarker for lupus nephritis (LN).
METHODS
We conducted a meta-analysis examining serum or urinary TWEAK levels in patients with systemic lupus erythematosus (SLE), patients with LN (active or inactive), and healthy controls. We tabulated correlation coefficients between urinary TWEAK level and total or renal SLE Disease Activity Index (tSLEDAI or rSLEDAI).
RESULTS
Eight studies were included in this meta-analysis. The meta-analysis revealed that serum TWEAK levels tended to be higher in patients with SLE than in controls (standard mean difference [SMD]=0.850, 95% confidence interval [CI]=−0.067∼1.767, p=0.069). Urinary TWEAK was significantly higher in patients with active LN than in those with inactive LN (SMD=2.865, 95% CI= −0.831∼4.898, p=0.006). In addition, urinary TWEAK was positively associated with tSLEDAI and rSLEDAI (correlation coefficient= 0.436, 95% CI=0.204∼0.622, p=4.3×10⁻⁴; correlation coefficient=0.483, 95% CI=0.108∼0.738, p=0.014). Pooled sensitivity and specificity of urinary TWEAK for diagnosis of LN were 81.3% (95% CI, 73.3∼87.8) and 76.0% (95% CI, 66.3∼84.2), indicating good diagnostic accuracy.
CONCLUSION
The meta-analysis demonstrated that urinary TWEAK was significantly higher in patients with active LN than in those with inactive LN, and that urinary TWEAK levels were positively correlated with renal disease activity.

Keyword

Urinary TWEAK; Lupus nephritis; Biomarker

MeSH Terms

Apoptosis*
Diagnosis
Humans
Lupus Erythematosus, Systemic
Lupus Nephritis*
Necrosis*
Sensitivity and Specificity

Figure

• 

  Figure 1. Meta-analysis of the relationship between serum TWEAK level and SLE compared with control (A), and between urinary TWEAK level and active LN compared with inactive LN (B). TWEAK: tumor necrosis factor-like weak inducer of apoptosis, SLE: systemic lupus erythematosus, LN: lupus nephritis, CI: confidence interval, Std diff: standardized difference.

• 

  Figure 2. Meta-analysis of the correlation coefficient between urinary TWEAK and total SLEDAI (A) and renal SLEDAI (B). TWEAK: tumor necrosis factor-like weak inducer of apoptosis, SLEDAI: systemic lupus erythematosus disease activity index, CI: confidence interval.

• 

  Figure 3. Summary receiver-operating characteristic curves for urinary TWEAK for the diagnosis of LN. Solid circles represent individual studies included in this meta-analysis. The curve shown is a regression line that summarizes the overall diagnostic accuracy. TWEAK: tumor necrosis factor-like weak inducer of apoptosis, LN: lupus nephritis, SROC: summary receiver operating characteristic, SE (AUC): standard error of the area under the curve, Q*: an index defined by the point on the SROC curve where the sensitivity and specificity are equal; and SE (Q*): Q* index standard error.

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