1Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Madrid, Spain. 2Pediatric Intensive Care Unit, Albacete General University Hospital, Albacete, Spain. 3Biochemistry and Laboratory Service, Albacete General University Hospital, Albacete, Spain.
Pediatr Crit Care Med. 2014 Feb;15(2):121-30. doi: 10.1097/PCC.0000000000000034.
We investigated the temporal pattern and predictive value of neutrophil gelatinase-associated lipocalin for early identification of acute kidney injury in children undergoing cardiac surgery.
Prospective observational cohort study.
One PICU in a tertiary medical center in Madrid, Spain.
One hundred six children older than 15 days and younger than 16 years undergoing surgery for congenital cardiac lesions.
None.
Urine samples were obtained before and at intervals after surgery. Acute kidney injury was defined according to pediatric Risk, Injury, Failure, Loss, and End-stage kidney disease criteria. The temporal pattern of both urine neutrophil gelatinase-associated lipocalin absolute concentration elevation and normalized to urine creatinine concentration was correlated with the development of acute kidney injury and other clinical outcomes. We evaluated the predictive ability of both urine neutrophil gelatinase-associated lipocalin and urine neutrophil gelatinase-associated lipocalin/creatinine by area under the curve, when added to a clinical predictive model. Data from 106 pediatric patients were analyzed. Acute kidney injury occurred in 42 patients (39.6%). Urine neutrophil gelatinase-associated lipocalin significantly increased in patients with acute kidney injury at 1, 3, and 15 hours postoperatively. Urine neutrophil gelatinase-associated lipocalin and urine neutrophil gelatinase-associated lipocalin/creatinine correlated with surgical variables and clinical outcomes. Acute kidney injury prediction improved when urine neutrophil gelatinase-associated lipocalin was added to a clinical model (area under the curve increased at 1 hr from 0.85 to 0.91 and at 3 hr to 0.92). Neither the urine neutrophil gelatinase-associated lipocalin nor the urine neutrophil gelatinase-associated lipocalin/creatinine values were significantly different between patients with prerenal and sustained acute kidney injury.
Urine neutrophil gelatinase-associated lipocalin is a predictive biomarker for acute kidney injury after pediatric cardiac surgery, and it may permit earlier intervention that improves outcome of acute kidney injury. Urine neutrophil gelatinase-associated lipocalin normalized to urine creatinine improves the prediction of acute kidney injury severity but offers no advantage in acute kidney injury diagnosis.
我们研究中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的时间模式及其对儿童心脏手术后急性肾损伤（AKI）早期识别的预测价值。
前瞻性观察队列研究。
西班牙马德里的一家三级医疗中心的 1 个儿科重症监护病房（PICU）。
106 名年龄大于 15 天且小于 16 岁的患儿，行心脏先天性病变手术。
无。
在手术前后采集尿液样本。根据儿科风险、损伤、衰竭、损失和终末期肾病（RIFLE）标准定义 AKI。尿液 NGAL 绝对浓度升高的时间模式及其与尿液肌酐浓度的比值与 AKI的发生及其他临床结局相关。我们评估了尿液 NGAL 和 NGAL/肌酐曲线下面积（AUC）对临床预测模型的预测能力。分析了 106 例患儿的数据。42 例患儿（39.6%）发生 AKI。尿液 NGAL 在术后 1、3 和 15 小时 AKI 患者中显著升高。尿液 NGAL 与手术变量和临床结局相关。当尿液 NGAL 添加到临床模型时，AKI 预测能力提高（1 小时 AUC 从 0.85 增加至 0.91，3 小时 AUC 增加至 0.92）。肾前性和持续性 AKI 患儿的尿液 NGAL 和 NGAL/肌酐值均无显著差异。
尿液 NGAL 是儿童心脏手术后 AKI 的预测生物标志物，可能有助于更早干预，改善 AKI 结局。尿液 NGAL 与尿液肌酐比值可提高 AKI 严重程度的预测，但对 AKI 诊断无优势。
