Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610-0224, USA.
J Nephrol. 2012 Jul-Aug;25(4):497-505. doi: 10.5301/jn.5000173.
We hypothesized that post-operative serum uric acid (SUA) may be associated with acute kidney injury (AKI).
In this prospective, observational study, the relationships between SUA, urine neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin-18 (uIL-18), serum monocyte chemoattractant protein-1 (sMCP-1) and tumor necrosis factor-alpha (sTNF-alpha), and incidence of AKI were determined. SUA were divided into tertiles and their association with AKI investigated.
A total of 100 cardiac surgery patients were included for analyses. The 1st, 2nd, and 3rd SUA tertiles were associated with 15.1%, 11.7%, and 54.5% incidence of AKI, respectively. The 3rd SUA tertile, compared to the referent 1st tertile, was associated with an eightfold (OR 8.38, CI95% 2.13-33.05, p=0.002) increased risk for AKI. Patients with AKI on post-operative day 1 (n=11) were then excluded for the purpose of determining the predictive value of SUA to diagnose AKI on postoperative day 2 and during hospital stay. In comparison to the referent 1st tertile, the 3rd tertile SUA was associated with an eightfold increased risk for AKI on post-operative day 2 (adjusted OR 7.94, CI95% 1.50-42.08, P=.015) and a five-fold increased risk for AKI during hospital stay (OR 4.83, CI95% 1.21-19.20, P=.025), respectively. SUA (Area Under Curve, AUC 0.77 (CI95% 0.66-0.88, P<.001), serum creatinine (0.73, CI95% 0.62-0.84, P<.001) and sTNF-alpha (0.76, CI95% 0.65-0.87, P<.001) had the best diagnostic performance measured by the Receiver Operating Characteristics curves.
We conclude that post-operative SUA is associated with an increased risk for AKI and compares well to conventional markers of AKI.
我们假设术后血尿酸（SUA）可能与急性肾损伤（AKI）有关。
在这项前瞻性观察研究中，我们确定了 SUA 与尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和白细胞介素-18（uIL-18）、血清单核细胞趋化蛋白-1（sMCP-1）和肿瘤坏死因子-α（sTNF-α）之间的关系，以及 AKI 的发生率。将 SUA 分为三分位，并研究其与 AKI 的关系。
共纳入 100 例心脏手术患者进行分析。第 1、2 和 3 个 SUA 三分位组 AKI 的发生率分别为 15.1%、11.7%和 54.5%。与参考第 1 三分位相比，第 3 三分位 SUA 与 AKI 的风险增加 8 倍（比值比 8.38，95%置信区间 2.13-33.05，p=0.002）。术后第 1 天发生 AKI 的患者（n=11）随后被排除在外，以确定 SUA 对术后第 2 天和住院期间 AKI 的诊断价值。与参考第 1 三分位相比，第 3 三分位 SUA 与术后第 2 天 AKI 的风险增加 8 倍相关（调整比值比 7.94，95%置信区间 1.50-42.08，P=.015），与住院期间 AKI 的风险增加 5 倍相关（比值比 4.83，95%置信区间 1.21-19.20，P=.025）。SUA（曲线下面积，AUC 0.77（95%置信区间 0.66-0.88，P<.001）、血清肌酐（0.73，95%置信区间 0.62-0.84，P<.001）和 sTNF-α（0.76，95%置信区间 0.65-0.87，P<.001）的诊断性能通过接受者操作特征曲线得到最佳评估。
我们的结论是，术后 SUA 与 AKI 的风险增加有关，与 AKI 的常规标志物相当。
