Fondazione Toscana G. Monasterio, Massa, Italy.
Clin Chem Lab Med. 2012 Nov;50(11):2009-17. doi: 10.1515/cclm-2012-0125.
The aim of this study is to test the hypothesis whether the combined use of a cardio-specific biomarker, the brain natriuretic peptide (BNP) and a marker of early renal damage, the assay of urinary neutrophil gelatinase-associated lipocalin (uNGAL), may improve risk stratification in pediatric cardiac surgery.
We prospectively enrolled 135 children [median age 7 (interquartile range 1-49) months] undergoing to cardiac surgery for congenital heart disease. All biomarkers were evaluated pre- and post-operatively at different times after cardiopulmonary-bypass (CPB): uNGAL at 2, 6 and 12 h; BNP at 12 and 36 h; serum creatinine at 2, 6, 12, and 36 h. Primary endpoints were development of acute kidney injury (AKI) (defined as 1.5 serum creatinine increase) and intubation time.
AKI occurred in 39% of patients (65% neonates and 32% older children, p=0.004). The peak of uNGAL values occurred more frequently at 2 h. uNGAL values at 2 h [median 28.2 (interquartile range 7.0-124.6) ng/L] had a good diagnostic accuracy for early diagnosis of AKI with an AUC (area under the curve) ROC (receiver operating characteristic) curve of 0.85 (SE 0.034). Using multivariable logistic regression analysis, development of AKI was significantly associated with uNGAL values at 2 h after CPB [OR=1.88 (1.30-2.72, p=0.001)], together with the CPB time and Aristotle score, as an index of complexity of the surgical procedure, while pre-operative BNP values were not. Furthermore, uNGAL and pre-operative BNP values (together with Aristotle score) were significantly associated with adverse outcome (longer intubation time and mortality).
Pre-operative BNP and uNGAL values after surgery (together with the Aristotle score) were independently associated with a more severe course and worse outcome in children undergoing cardiac surgery for congenital heart disease.
本研究旨在验证假设，即联合使用心脏特异性生物标志物脑利钠肽（BNP）和早期肾损伤标志物尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL），是否可以改善儿科心脏手术的风险分层。
我们前瞻性纳入了 135 名（中位年龄 7 岁[四分位间距 1-49 个月]）接受先天性心脏病心脏手术的儿童。所有生物标志物在体外循环（CPB）后不同时间进行术前和术后评估：uNGAL 在 2、6 和 12 小时；BNP 在 12 和 36 小时；血清肌酐在 2、6、12 和 36 小时。主要终点为急性肾损伤（AKI）的发生（定义为血清肌酐增加 1.5 倍）和插管时间。
39%的患者（65%为新生儿，32%为大龄儿童）发生 AKI（p=0.004）。uNGAL 峰值更常出现在 2 小时。CPB 后 2 小时 uNGAL 值[中位数 28.2（四分位间距 7.0-124.6）ng/L]对 AKI 的早期诊断具有良好的诊断准确性，ROC 曲线下面积（AUC）为 0.85（SE 0.034）。使用多变量逻辑回归分析，AKI 的发生与 CPB 后 2 小时 uNGAL 值显著相关[OR=1.88（1.30-2.72，p=0.001）]，同时与 CPB 时间和 Aristotle 评分（作为手术复杂性的指标）相关，而术前 BNP 值则不相关。此外，uNGAL 和术前 BNP 值（与 Aristotle 评分一起）与不良结局（更长的插管时间和死亡率）显著相关。
术前 BNP 和术后 uNGAL 值（与 Aristotle 评分一起）与接受先天性心脏病心脏手术的儿童更严重的病程和更差的结局独立相关。
