中性粒细胞明胶酶相关载脂蛋白预测肝移植患者急性肾损伤。

Neutrophil gelatinase--associated lipocalin predicts acute kidney injury in patients undergoing liver transplantation.

机构信息

Institute of Liver Studies, Denmark Hill, London, England.

出版信息

Liver Transpl. 2010 Nov;16(11):1257-66. doi: 10.1002/lt.22158.

Abstract

Postoperative acute kidney injury (AKI) increases morbidity and mortality after liver transplantation (LT). Novel methods of assessing AKI including cystatin C (CyC) and neutrophil gelatinase-associated lipocalin (NGAL) have been identified as potential markers of AKI. We compare the ability of standard renal markers (serum creatinine [sCr], estimated glomerular filtration rate [eGFR] and intensive therapy unit organ failure scores with CyC and NGAL to predict AKI within the first 48 hours after LT. 95 patients (median age 50 [interquartile range = 41-59], 60% male) underwent LT (25% with acute liver failure). AKI was defined according to the Acute Kidney Injury Network criteria. Severe AKI was classified as ≥stage 2. NGAL (urine [u] and plasma [p]) and CyC concentrations taken immediately after transplantation on admission to the Liver Intensive Care Unit were compared with standard markers of renal function. Predictive ability was assessed using the area under the curve generated by receiver operator characteristic analysis (AUROC) and logistic regression. Day 0 sCr, uNGAL, pNGAL, CyC, and eGFR predicted AKI as did SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation II) scores. APACHE II and pNGAL were the most powerful predictors of severe AKI (APACHE II AUROC = 0.87 [0.77-0.97], P < 0.001; pNGAL AUROC = 0.87 [0.77-0.92], P < 0.001). Using multivariate logistic regression, APACHE II (odds ratio 1.64/point [95% confidence interval = 1.22-2.21, P = 0.001] and pNGAL [odds ratio = 1.01/ng/mL [95% confidence interval = 1.00-1.02], P = 0.002) retained independent significance. A "renal risk score" using APACHE II > 13 and pNGAL > 258 ng/mL was calculated with a score of ≥1 having a 100% sensitivity and 76% specificity for severe AKI. In conclusion, a combination of NGAL and APACHE II predicts AKI with high sensitivity and specificity after LT.

摘要

术后急性肾损伤(AKI)增加肝移植(LT)后的发病率和死亡率。已经确定了包括胱抑素 C(CyC)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在内的新的 AKI 评估方法,作为 AKI 的潜在标志物。我们比较了标准肾脏标志物(血清肌酐[sCr]、估算肾小球滤过率[eGFR]和重症监护病房器官衰竭评分)与 CyC 和 NGAL 预测 LT 后 48 小时内 AKI 的能力。95 名患者(中位年龄 50[四分位间距=41-59],60%为男性)接受了 LT(25%为急性肝衰竭)。根据急性肾损伤网络标准定义 AKI。严重 AKI 分类为≥2 期。比较了移植后立即在肝重症监护病房入院时采集的尿[u]和血浆[p]NGAL 和 CyC 浓度与肾功能的标准标志物。使用接收者操作特征分析(AUROC)生成的曲线下面积评估预测能力,并进行逻辑回归分析。术后第 0 天 sCr、uNGAL、pNGAL、CyC 和 eGFR 以及 SOFA(序贯器官衰竭评估)和 APACHE II(急性生理学和慢性健康评估 II)评分均能预测 AKI。APACHE II 和 pNGAL 是严重 AKI 最强的预测因子(APACHE II AUROC=0.87[0.77-0.97],P<0.001;pNGAL AUROC=0.87[0.77-0.92],P<0.001)。使用多变量逻辑回归,APACHE II(优势比 1.64/分[95%置信区间=1.22-2.21,P=0.001]和 pNGAL[比值比=1.01/ng/mL[95%置信区间=1.00-1.02],P=0.002])保留了独立意义。使用 APACHE II>13 和 pNGAL>258ng/mL 计算的“肾脏风险评分”,得分≥1 对严重 AKI 的灵敏度为 100%,特异性为 76%。总之,NGAL 和 APACHE II 的组合预测 LT 后 AKI 的灵敏度和特异性较高。

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