Department of Nephrology and Hypertension, Diabetes & Endocrinology, Otto-von-Guericke-University Magdeburg, Germany.
J Thorac Cardiovasc Surg. 2013 May;145(5):1380-6. doi: 10.1016/j.jtcvs.2012.09.003. Epub 2012 Oct 9.
Hepcidin regulates iron absorption and recycling and is central to host defense, protection from reactive iron species, and a biomarker of iron-related pathophysiology. We assessed the value of hepcidin measured preoperatively for the prediction of in-hospital mortality and renal outcomes.
We studied 100 adult patients undergoing cardiac surgery in the control arm of a randomized, controlled trial. Plasma and urine were sampled before induction of anesthesia, and hepcidin-25 was quantified by competitive enzyme-linked immunoassay. Renal outcomes were acute kidney injury defined by risk, injury, failure, loss of function, end-stage renal disease (RIFLE) classification and need for renal replacement therapy. Variables with the potential to influence hepcidin expression were investigated.
Low preoperative hepcidin concentration in urine (median, 15.3 ng/mL; 25-75 percentiles, 0-129.1) and plasma (median, 49.2 ng/mL; 25th-75th percentile, 0-52.2) predicted mortality (area under the curve-receiver operating characteristic [AUC-ROC] for urine hepcidin, 0.89; 95% confidence interval, 0.73-0.99; cutoff, 130 ng/mL; sensitivity, 73%; specificity, 100%; and AUC-ROC for plasma hepcidin, 0.90; 95% confidence interval, 0.80-0.99; cutoff, 55 ng/mL; sensitivity, 83%; specificity, 100%). Survivors had median preoperative hepcidin concentrations of 325.3 ng/mL (25th-75th percentile, 120-770.1 ng/mL) in urine and 113.1 ng/mL (25th-75th percentile, 77.7-203.1 ng/mL) in plasma. Preoperative serum creatinine did not predict mortality (AUC-ROC, 0.50; 95% confidence interval, 0.10-0.94). Furthermore, preoperative urine, plasma hepcidin, and serum creatinine did not distinguish patients requiring postoperative renal replacement therapy from those without (urine: AUC-ROC, 0.62; 95% confidence interval, 0.38-0.86; plasma: AUC-ROC, 0.63; 95% confidence interval, 0.34-0.91; serum creatinine: AUC-ROC, 0.61; 95% confidence interval, 0.22-0.99). Preoperative renal function and hemoglobin did not correlate with hepcidin indices whereas plasma markers of inflammation did.
Low preoperative hepcidin concentration might be a risk factor for in-hospital mortality. Findings should be validated in larger patient cohorts with a greater number of events.
铁调素调节铁的吸收和循环，是宿主防御、抵抗活性铁物质以及铁相关病理生理学的生物标志物的核心。我们评估了术前铁调素测量值对住院死亡率和肾脏结局的预测价值。
我们研究了随机对照试验中 100 名接受心脏手术的成年患者的对照臂。在麻醉诱导前采集血浆和尿液样本，并通过竞争性酶联免疫吸附试验定量测定铁调素-25。肾脏结局为急性肾损伤定义为风险、损伤、衰竭、功能丧失、终末期肾病（RIFLE）分类和需要肾脏替代治疗。研究了可能影响铁调素表达的变量。
术前尿液（中位数，15.3ng/ml；25-75 百分位数，0-129.1）和血浆（中位数，49.2ng/ml；25-75 百分位数，0-52.2）中低浓度的铁调素预测死亡率（尿液铁调素的曲线下面积-接受者操作特征 [AUC-ROC]，0.89；95%置信区间，0.73-0.99；临界值，130ng/ml；敏感性，73%；特异性，100%；血浆铁调素的 AUC-ROC，0.90；95%置信区间，0.80-0.99；临界值，55ng/ml；敏感性，83%；特异性，100%）。幸存者术前尿液铁调素浓度中位数为 325.3ng/ml（25-75 百分位数，120-770.1ng/ml），血浆铁调素浓度中位数为 113.1ng/ml（25-75 百分位数，77.7-203.1ng/ml）。术前血清肌酐不能预测死亡率（AUC-ROC，0.50；95%置信区间，0.10-0.94）。此外，术前尿液、血浆铁调素和血清肌酐不能区分需要术后肾脏替代治疗的患者与不需要的患者（尿液：AUC-ROC，0.62；95%置信区间，0.38-0.86；血浆：AUC-ROC，0.63；95%置信区间，0.34-0.91；血清肌酐：AUC-ROC，0.61；95%置信区间，0.22-0.99）。术前肾功能和血红蛋白与铁调素指数不相关，而血浆炎症标志物则相关。
术前低浓度铁调素可能是住院死亡率的危险因素。应在更大的患者队列中进行更多事件的验证。
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