Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Biomarkers. 2013 Feb;18(1):95-101. doi: 10.3109/1354750X.2012.740687. Epub 2012 Nov 21.
BACKGROUND/AIM: The early detection of acute kidney injury (AKI) may be become possible by several promising early biomarkers which may facilitate the early detection, differentiation and prognosis prediction of AKI. In this study, we investigated the value of urinary liver-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL) and their combination in predicting the occurrence and the severity of AKI following cardiac surgery.
We prospectively followed 109 patients undergoing open heart surgery and identified 26 that developed AKI, defined as an increase in serum creatinine of ≥0.3 mg/dl or ≥150% of baseline creatinine. Serum creatinine (SCr), urinary L-FABP, and NGAL corrected by urine creatinine were tested pre-operation, at 0 hour and 2 hours post-operation. Each marker was assessed at each time point between patients with and without AKI. Receiver operating characteristic (ROC) curves and area under curves (AUC) were used to evaluate the diagnostic accuracy of urinary L-FABP, NGAL and their combination for predicting AKI.
Patients were aged 63.0 ± 11.3 years, 66.1% were male and baseline SCr was 70.5 ± 19.1 umol/L. Of 109 patients, 26(23.9%) developed AKI (AKIN stage I, II and III were 46.2%, 34.6% and 19.2% separately). The levels of urinary L-FABP and NGAL were significantly higher in AKI patients than non-AKI patients at 0 hour and 2 hours postoperative. AUCs for L-FABP was 0.844 (sensitivity (ST) 0.846, specificity (SP) 0.819, cut-off (CO) 2226.50 μg/g Ucr) at 0 hours and 0.832 at 2 hours (ST 0.808, SP 0.747, CO 673.09 μg/g Ucr) while 0.866 for NGAL at 0 hours (ST 0.769, SP 0.819, CO 131.12 μg/g Ucr) and 0.871 at 2 hours (ST 0.808, SP 0.831, CO 33.73 μg/g Ucr) to predict AKI occurrence. Using a combination of L-FABP and NGAL analyzed at the same timepoint as above, we were able to obtain an AUC of 0.911-0.927, p < 0.001. Similar AUCs of 0.81-0.87 were found to predict AKI stage II-III.
Urinary L-FABP and NGAL increased at an early stage after cardiac surgery. The combination of the two biomarkers enhanced the accuracy of the early detection of postoperative AKI after cardiac surgery before a rise in SCr.
背景/目的：几种有前途的早期生物标志物可能使急性肾损伤（AKI）的早期检测成为可能，这些标志物可能有助于 AKI 的早期检测、鉴别和预后预测。本研究旨在探讨尿肝型脂肪酸结合蛋白（L-FABP）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）及其联合检测在预测心脏手术后 AKI 发生和严重程度中的价值。
前瞻性随访 109 例行开胸心脏手术的患者，其中 26 例发生 AKI，定义为血清肌酐升高≥0.3mg/dl 或基线肌酐升高≥150%。分别于术前、术后 0 小时和 2 小时检测血清肌酐（SCr）、尿 L-FABP 和尿肌酐校正的 NGAL。在有和无 AKI 的患者之间，在每个时间点评估每个标志物。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估尿 L-FABP、NGAL 及其联合检测预测 AKI 的诊断准确性。
患者年龄为 63.0±11.3 岁，66.1%为男性，基线 SCr 为 70.5±19.1μmol/L。109 例患者中，26 例（AKIN Ⅰ期、Ⅱ期和Ⅲ期分别为 46.2%、34.6%和 19.2%）发生 AKI。术后 0 小时和 2 小时，AKI 患者的尿 L-FABP 和 NGAL 水平明显高于非 AKI 患者。0 小时 L-FABP 的 AUC 为 0.844（敏感性（ST）0.846，特异性（SP）0.819，截断值（CO）2226.50μg/g Ucr），2 小时时为 0.832（ST 0.808，SP 0.747，CO 673.09μg/g Ucr），而 0 小时时 NGAL 的 AUC 为 0.866（ST 0.769，SP 0.819，CO 131.12μg/g Ucr），2 小时时为 0.871（ST 0.808，SP 0.831，CO 33.73μg/g Ucr），预测 AKI 发生。使用上述同时分析的 L-FABP 和 NGAL 的组合，我们能够获得 0.911-0.927 的 AUC，p<0.001。发现 AUC 相似的 0.81-0.87 可预测 AKI Ⅱ-Ⅲ期。
心脏手术后早期尿 L-FABP 和 NGAL 升高。两种生物标志物的联合检测可在 SCr 升高前提高心脏手术后 AKI 的早期检测准确性。
