Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Clin J Am Soc Nephrol. 2010 Aug;5(8):1497-505. doi: 10.2215/CJN.09061209. Epub 2010 Jun 17.
Urine IL-18 (uIL-18) has demonstrated moderate capacity to predict acute kidney injury (AKI) and adverse outcomes in defined settings. Its ability to predict AKI and provide prognostic information in broadly selected, critically ill adults remains unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study prospectively evaluated the capacity of uIL-18 measured within 24 hours of intensive care unit (ICU) admission to predict AKI, death, and receipt of acute dialysis in a large mixed-adult ICU population.
Of 451 patients, 86 developed AKI within 48 hours of enrollment and had higher median uIL-18 levels [426 (interquartile range [IQR]: 152 to 1183) pg/mg creatinine] compared with those without AKI [248 (IQR: 120 to 559) pg/mg]. The area under the receiver operating characteristic curve for uIL-18 predicting subsequent AKI within 24 hours was 0.62 (95% CI: 0.54 to 0.69) and improved modestly to 0.67 (95% CI: 0.53 to 0.81) in patients whose enrollment eGFR was >or=75 ml/min per 1.73 m(2). The highest median uIL-18 levels were observed in patients with sepsis at enrollment [508 (IQR: 230 to 1281) pg/mg], those receiving acute dialysis [571 (IQR: 161 to 1614) pg/mg] or dying [532 (IQR: 210 to 1614) pg/mg] within 28 days of ascertainment. After adjustment for a priori selected clinical predictors, uIL-18 remained independently predictive of composite outcome of death or acute dialysis within 28 days of ascertainment (odds ratio, 1.86 [95% CI: 1.31 to 2.64]).
uIL-18 did not reliably predict AKI development, but did predict poor clinical outcomes in a broadly selected, critically ill adult population.
尿液白细胞介素-18（uIL-18）在特定环境中对急性肾损伤（AKI）和不良结局有一定的预测能力。但其在广泛选择的重症成人患者中预测 AKI 并提供预后信息的能力尚不清楚。
设计、地点、参与者和测量方法：本研究前瞻性评估了 ICU 入院后 24 小时内测量的 uIL-18 预测 AKI、死亡和接受急性透析的能力，该研究纳入了一个大型混合成人 ICU 人群。
451 例患者中，86 例在入组后 48 小时内发生 AKI，其 uIL-18 水平中位数较高[426（四分位距 [IQR]：152 至 1183）pg/mg 肌酐]，而无 AKI 的患者 uIL-18 水平中位数较低[248（IQR：120 至 559）pg/mg 肌酐]。uIL-18 预测 24 小时内 AKI 的受试者工作特征曲线下面积为 0.62（95%CI：0.54 至 0.69），在 eGFR ＞或=75 ml/min/1.73 m2 的患者中，该面积略有提高至 0.67（95%CI：0.53 至 0.81）。在入组时患有败血症的患者中观察到最高的 uIL-18 水平[508（IQR：230 至 1281）pg/mg]，在接受急性透析的患者[571（IQR：161 至 1614）pg/mg]或在确定后 28 天内死亡的患者[532（IQR：210 至 1614）pg/mg]中观察到最高的 uIL-18 水平。在对预先选择的临床预测因素进行调整后，uIL-18 仍然独立预测确定后 28 天内死亡或急性透析的复合结局（比值比，1.86 [95%CI：1.31 至 2.64]）。
uIL-18 不能可靠地预测 AKI 的发生，但可以预测广泛选择的重症成人患者的不良临床结局。
