Section of Nephrology, Yale University and VAMC, 950 Campbell Avenue, Mail Code 151B, West Haven, CT 06516, USA.
J Am Soc Nephrol. 2011 Sep;22(9):1737-47. doi: 10.1681/ASN.2010111163. Epub 2011 Aug 11.
Acute kidney injury (AKI) occurs commonly after pediatric cardiac surgery and associates with poor outcomes. Biomarkers may help the prediction or early identification of AKI, potentially increasing opportunities for therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 311 children undergoing surgery for congenital cardiac lesions to evaluate whether early postoperative measures of urine IL-18, urine neutrophil gelatinase-associated lipocalin (NGAL), or plasma NGAL could identify which patients would develop AKI and other adverse outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. Severe AKI, defined by dialysis or doubling in serum creatinine during hospital stay, occurred in 53 participants at a median of 2 days after surgery. The first postoperative urine IL-18 and urine NGAL levels strongly associated with severe AKI. After multivariable adjustment, the highest quintiles of urine IL-18 and urine NGAL associated with 6.9- and 4.1-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine NGAL levels associated with longer hospital stay, longer intensive care unit stay, and duration of mechanical ventilation. The accuracy of urine IL-18 and urine NGAL for diagnosis of severe AKI was moderate, with areas under the curve of 0.72 and 0.71, respectively. The addition of these urine biomarkers improved risk prediction over clinical models alone as measured by net reclassification improvement and integrated discrimination improvement. In conclusion, urine IL-18 and urine NGAL, but not plasma NGAL, associate with subsequent AKI and poor outcomes among children undergoing cardiac surgery.
急性肾损伤（AKI）在小儿心脏手术后很常见，与不良预后相关。生物标志物可能有助于预测或早期识别 AKI，从而增加治疗干预的机会。在此，我们进行了一项前瞻性、多中心队列研究，纳入了 311 名接受先天性心脏病变手术的儿童，以评估术后早期尿液白细胞介素 18（IL-18）、尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）或血浆 NGAL 是否可以识别哪些患者会发生 AKI 和其他不良结局。尿液 IL-18 和尿液及血浆 NGAL 水平在术后 6 小时内达到峰值。53 名参与者在术后中位数为 2 天发生严重 AKI，定义为透析或住院期间血清肌酐加倍。术后第 1 天的尿液 IL-18 和尿液 NGAL 水平与严重 AKI 密切相关。多变量调整后，尿液 IL-18 和尿液 NGAL 的最高五分位数与 AKI 的比值分别为 6.9 倍和 4.1 倍，与最低五分位数相比。尿液 IL-18 和尿液 NGAL 水平升高与住院时间延长、重症监护病房停留时间延长和机械通气时间延长相关。尿液 IL-18 和尿液 NGAL 诊断严重 AKI 的准确性中等，曲线下面积分别为 0.72 和 0.71。与单独使用临床模型相比，这些尿液生物标志物的加入可提高风险预测能力，表现为净重新分类改善和综合判别改善。总之，尿液 IL-18 和尿液 NGAL 与心脏手术后发生 AKI 和不良结局相关，而血浆 NGAL 则不然。
