Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Nephrol Dial Transplant. 2014 Jan;29(1):73-80. doi: 10.1093/ndt/gft414. Epub 2013 Oct 28.
Predicting the development of acute kidney injury (AKI) in the critical care setting is challenging. Although several biomarkers showed somewhat satisfactory performance for detecting established AKI even in a heterogeneous disease-oriented population, identification of new biomarkers that predict the development of AKI accurately is urgently required.
A single-center prospective observational cohort study was undertaken to evaluate for the first time the reliability of the newly identified biomarker semaphorin 3A for AKI diagnosis in heterogeneous intensive care unit populations. In addition to five urinary biomarkers of L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), IL-18, albumin and N-acetyl-β-d-glucosaminidase (NAG), urinary semaphorin 3A was measured at intensive care unit (ICU) admission.
Three hundred thirty-nine critically ill adult patients were recruited for this study. Among them, 131 patients (39%) were diagnosed with AKI by the RIFLE criteria and 66 patients were diagnosed as AKI at post-ICU admission (later-onset AKI). Eighty-four AKI patients showed worsening severity during 1 week observation (AKI progression). Although L-FABP, NGAL and IL-18 showed significantly higher area under the curve (AUC)-receiver operating characteristic (ROC) values than semaphorin 3A in detecting established AKI, semaphorin 3A was able to detect later-onset AKI and AKI progression with similar AUC-ROC values compared with the other five biomarkers [AUC-ROC (95% CI) for established AKI 0.64 (0.56-0.71), later-onset AKI 0.71 (0.64-0.78), AKI progression 0.71 (0.64-0.77)]. Urinary semaphorin 3A was not increased in non-progressive established AKI, while the other biomarkers were elevated regardless of further progression. Finally, sepsis did not have any impact on semaphorin 3A while the other urinary biomarkers were increased with sepsis. Semaphorin 3A is a new biomarker of AKI which may have a distinct predictive use for AKI progression when compared with other AKI biomarkers.
在重症监护环境中预测急性肾损伤（AKI）的发展具有挑战性。尽管一些生物标志物在异质性疾病导向的人群中检测已建立的 AKI 时表现出相当令人满意的性能，但迫切需要鉴定新的生物标志物来准确预测 AKI 的发展。
进行了一项单中心前瞻性观察队列研究，首次评估新鉴定的生物标志物 Semaforein 3A 对异质性重症监护病房人群 AKI 诊断的可靠性。除了 L 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）、IL-18、白蛋白和 N-乙酰-β-D-氨基葡萄糖苷酶（NAG）的五种尿生物标志物外，在重症监护病房（ICU）入院时还测量了尿 Semaforein 3A。
共纳入 339 例成年危重病患者进行本研究。其中，131 例患者（39%）根据 RIFLE 标准诊断为 AKI，66 例患者在 ICU 后入住（迟发性 AKI）时诊断为 AKI。84 例 AKI 患者在 1 周观察期间出现严重程度恶化（AKI 进展）。尽管 L-FABP、NGAL 和 IL-18 在检测已建立的 AKI 时显示出显著较高的曲线下面积（AUC）-接收者操作特征（ROC）值，但与其他五种生物标志物相比，Semaforein 3A 能够检测迟发性 AKI 和 AKI 进展具有相似的 AUC-ROC 值[已建立 AKI 的 AUC-ROC（95%CI）为 0.64（0.56-0.71），迟发性 AKI 为 0.71（0.64-0.78），AKI 进展为 0.71（0.64-0.77）]。非进行性已建立 AKI 时尿 Semaforein 3A 未增加，而其他生物标志物无论是否进一步进展均升高。最后，败血症对 Semaforein 3A 没有任何影响，而其他尿生物标志物随着败血症的发生而增加。Semaforein 3A 是 AKI 的一种新生物标志物，与其他 AKI 生物标志物相比，它在预测 AKI 进展方面可能具有独特的应用价值。
