Tiranathanagul Khajohn, Amornsuntorn Sukgasem, Avihingsanon Yingyos, Srisawat Nattachai, Susantitaphong Paweena, Praditpornsilpa Kearkiat, Tungsanga Kriang, Eiam-Ong Somchai
Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
Ther Apher Dial. 2013 Jun;17(3):332-8. doi: 10.1111/1744-9987.12004. Epub 2013 Jan 22.
Delayed initiation of renal replacement therapy (RRT) in critically ill acute kidney injury (AKI) patients results in high mortality while too early RRT causes unnecessary risks of the treatment. Current traditional indications cannot clearly identify the appropriate time for initiating RRT. This prospective cohort study was conducted to determine the accuracy of using plasma neutrophil gelatinase-associated lipocalin (pNGAL) and urine NGAL (uNGAL) in early identifying of the AKI patients who subsequently required RRT. Forty-seven critically ill patients with AKI stage 2-3 who did not reach the traditional indications for RRT were enrolled in this study. The pNGAL, uNGAL, and other parameters were determined in each patient. The primary end point was RRT initiation according to the traditional indications within 3 days. The mean age of the patients was 63.0 ± 18.1 years. pNGAL could predict subsequent RRT requirements with area under ROC 0.813 (P < 0.001, 95%CI 0.66-0.90). The cut-off point of 960 ng/mL provided sensitivity and specificity of 72.2 and 89.6%, respectively, and positive and negative predictive values of 81.25% and 83.8%, respectively. The uNGAL provided slightly lower significance of statistical parameters. The combination of pNGAL level of 960 ng/mL and APACHE II score of 20 improved statistical values. In conclusion, pNGAL is an excellent early biomarker for RRT initiation in critically ill patients with AKI stage 2-3. The pNGAL value of 960 ng/mL, alone or in combination with APACHE II score might be used as the early new indicator for early initiation of RRT in AKI stage 2-3 and this might improve patient survival.
危重症急性肾损伤（AKI）患者延迟启动肾脏替代治疗（RRT）会导致高死亡率，而过早进行RRT则会带来不必要的治疗风险。目前的传统指征无法明确确定启动RRT的合适时机。本前瞻性队列研究旨在确定使用血浆中性粒细胞明胶酶相关脂质运载蛋白（pNGAL）和尿NGAL（uNGAL）早期识别随后需要RRT的AKI患者的准确性。本研究纳入了47例未达到RRT传统指征的AKI 2-3期危重症患者。测定了每位患者的pNGAL、uNGAL及其他参数。主要终点是在3天内根据传统指征启动RRT。患者的平均年龄为63.0±18.1岁。pNGAL能够预测后续RRT需求，ROC曲线下面积为0.813（P<0.001，95%CI 0.66-0.90）。960 ng/mL的截断点提供的敏感性和特异性分别为72.2%和89.6%，阳性和阴性预测值分别为81.25%和83.8%。uNGAL的统计参数意义稍低。960 ng/mL的pNGAL水平与APACHE II评分为20相结合可提高统计值。总之，pNGAL是AKI 2-3期危重症患者启动RRT的优秀早期生物标志物。960 ng/mL的pNGAL值单独或与APACHE II评分相结合，可作为AKI 2-3期早期启动RRT的新早期指标，这可能会提高患者生存率。
