血浆中性粒细胞明胶酶相关载脂蛋白是成年危重症患者急性肾损伤的早期标志物：一项前瞻性研究。
Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: a prospective study.
机构信息
Surgical intensive care unit, Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
出版信息
J Crit Care. 2010 Mar;25(1):176.e1-6. doi: 10.1016/j.jcrc.2009.05.010. Epub 2009 Sep 24.
PURPOSE
The aim of the study was to assess the ability of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict acute kidney injury (AKI) in adult intensive care unit (ICU) patients.
METHODS
All consecutives patients admitted to 3 ICUs were enrolled in this prospective-observational study. Plasma neutrophil gelatinase-associated lipocalin was analyzed at ICU admission. Risk, injury, failure, loss, and end-stage kidney (RIFLE) criteria were calculated at admission and for each day during the first week. Patients were classified according to whether they met the threshold for RIFLE criteria (RIFLE 0 or 1) at admission and during the first week. Four groups were identified: RIFLE (0-0), (1-1), (1-0), and (0-1).
RESULTS
During this 1-month period, 88 patients were included in the study. Thirty-six patients met the criteria for RIFLE 0-0 with a mean pNGAL of 98 +/- 60 nmol/L, 22 for RIFLE 1-1 with a mean pNGAL of 516 +/- 221 nmol/L, and 20 patients had no AKI at admission but develop AKI at 48 hours (24-96 hours) (RIFLE 0-1) with a pNGAL of 342 +/- 183 nmol/L. Ten patients met the criteria for RIFLE 1-0 and had a mean pNGAL of 169 +/- 100 nmol/L. Using a cutoff of 155 nmol/L, sensitivity and specificity to predict AKI were 82% and 97%, respectively (area under the curve [AUC] = 0.92 [0.852-0.972]; P = .001). Looking at the patients without AKI at admission (n = 56) and who developed (n = 20) or did not develop (n = 36) AKI, receiver operating characteristic curve analysis was as follows: AUC = 0.956 (0.864-0.992). Sensitivity was 85% and specificity was 97%. Of the 7 patients who required renal replacement therapy, all of them had pNGAL of more than 303 nmol/L (AUC = 0.788 [0.687-0.868]).
CONCLUSION
Plasma neutrophil gelatinase-associated lipocalin at ICU admission is an early biomarker of AKI in adult ICU patients. Plasma neutrophil gelatinase-associated lipocalin increased 48 hours before RIFLE criteria.
目的
本研究旨在评估血浆中性粒细胞明胶酶相关脂质运载蛋白（pNGAL）预测成人重症监护病房（ICU）患者急性肾损伤（AKI）的能力。
方法
本前瞻性观察性研究纳入了 3 个 ICU 连续收治的所有患者。在 ICU 入院时分析血浆中性粒细胞明胶酶相关脂质运载蛋白。在入院时和第 1 周的每一天计算风险、损伤、衰竭、丧失和终末期肾脏（RIFLE）标准。根据入院时和第 1 周是否达到 RIFLE 标准的阈值（RIFLE 0 或 1）对患者进行分类。确定了 4 个组：RIFLE（0-0）、（1-1）、（1-0）和（0-1）。
结果
在这 1 个月期间，共有 88 例患者纳入研究。36 例患者符合 RIFLE 0-0 标准，平均 pNGAL 为 98 ± 60 nmol/L，22 例患者符合 RIFLE 1-1 标准，平均 pNGAL 为 516 ± 221 nmol/L，20 例患者入院时无 AKI，但在 48 小时（24-96 小时）出现 AKI（RIFLE 0-1），pNGAL 为 342 ± 183 nmol/L。10 例患者符合 RIFLE 1-0 标准，平均 pNGAL 为 169 ± 100 nmol/L。使用 155 nmol/L 的截断值，预测 AKI 的灵敏度和特异性分别为 82%和 97%（曲线下面积[AUC]为 0.92[0.852-0.972]；P =.001）。对于入院时无 AKI 的 56 例患者（n=56）和发生 AKI 的 20 例患者（n=20）或未发生 AKI 的 36 例患者（n=36），受试者工作特征曲线分析如下：AUC=0.956（0.864-0.992）。灵敏度为 85%，特异性为 97%。在需要肾脏替代治疗的 7 例患者中，pNGAL 均超过 303 nmol/L（AUC=0.788[0.687-0.868]）。
结论
成人 ICU 患者 ICU 入院时的血浆中性粒细胞明胶酶相关脂质运载蛋白是 AKI 的早期生物标志物。pNGAL 在 RIFLE 标准出现前 48 小时增加。
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