尿蛋白中性粒细胞明胶酶相关脂质运载蛋白可预测重症成年患者的肾脏替代治疗，但不能预测急性肾损伤或90天死亡率。

The urine protein NGAL predicts renal replacement therapy, but not acute kidney injury or 90-day mortality in critically ill adult patients.

作者信息

Nisula Sara, Yang Runkuan, Kaukonen Kirsi-Maija, Vaara Suvi T, Kuitunen Anne, Tenhunen Jyrki, Pettilä Ville, Korhonen Anna-Maija

机构信息

From the Department of Surgery, Division of Anesthesia and Intensive Care Medicine, Intensive Care Units, Helsinki University Central Hospital, Helsinki; Department of Intensive Care Medicine, Critical Care Medicine Research Group, Tampere University Hospital, Tampere, Finland; Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Surgical Sciences/Anesthesiology and Intensive Care, University of Uppsala, Uppsala, Sweden.

出版信息

Anesth Analg. 2014 Jul;119(1):95-102. doi: 10.1213/ANE.0000000000000243.

DOI:10.1213/ANE.0000000000000243

PMID:24806144

Abstract

BACKGROUND

Urine neutrophil gelatinase-associated lipocalin (uNGAL) is increasingly used as a biomarker for acute kidney injury (AKI). However, the clinical value of uNGAL with respect to AKI, renal replacement therapy (RRT), or 90-day mortality in critically ill patients is unclear. Accordingly, we tested the hypothesis that uNGAL is a clinically relevant biomarker for these end points in a large, nonselected cohort of critically ill adult patients.

METHODS

We prospectively obtained urine samples from 1042 adult patients admitted to 15 Finnish intensive care units. We analyzed 3 samples (on admission, at 12 hours, and at 24 hours) with NGAL ELISA Rapid Kits (BioPorto® Diagnostics, Gentofte, Denmark). We chose the highest uNGAL (uNGAL24) for statistical analyses. We calculated the areas under receiver operating characteristics curves (AUC) with 95% confidence intervals (95% CIs), the best cutoff points with the Youden index, positive likelihood ratios (LR+), continuous net reclassification improvement (NRI), and the integrated discrimination improvement (IDI). We performed sensitivity analyses excluding patients with AKI or RRT on day 1, sepsis, or with missing baseline serum creatinine concentration.

RESULTS

In this study population, the AUC of uNGAL24 (95% CI) for development of AKI (defined by the Kidney Disease: Improving Global Outcomes [KDIGO] criteria) was 0.733 (0.701-0.765), and the continuous NRI for AKI was 56.9%. For RRT, the AUC of uNGAL24 (95% CI) was 0.839 (0.797-0.880), and NRI 56.3%. For 90-day mortality, the AUC of uNGAL24 (95% CI) was 0.634 (0.593 to 0.675), and NRI 15.3%. The LR+ (95% CI) for RRT was 3.81 (3.26-4.47).

CONCLUSION

In this study, we found that uNGAL associated well with the initiation of RRT but did not provide additional predictive value regarding AKI or 90-day mortality in critically ill patients.

摘要

背景

尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）越来越多地被用作急性肾损伤（AKI）的生物标志物。然而，uNGAL在危重症患者的AKI、肾脏替代治疗（RRT）或90天死亡率方面的临床价值尚不清楚。因此，我们在一个大型的、未经过筛选的成年危重症患者队列中检验了以下假设：uNGAL是这些终点的临床相关生物标志物。

方法

我们前瞻性地收集了来自芬兰15个重症监护病房的1042例成年患者的尿液样本。我们使用NGAL ELISA快速检测试剂盒（BioPorto Diagnostics，丹麦根措夫特）分析了3份样本（入院时、12小时和24小时）。我们选择最高的uNGAL（uNGAL24）进行统计分析。我们计算了受试者工作特征曲线下面积（AUC）及其95%置信区间（95%CI）、Youden指数确定的最佳截断点、阳性似然比（LR+）、连续净重新分类改善（NRI）和综合判别改善（IDI）。我们进行了敏感性分析，排除了第1天患有AKI或接受RRT、患有脓毒症或基线血清肌酐浓度缺失的患者。

结果

在本研究人群中，uNGAL24（95%CI）预测AKI（根据改善全球肾脏病预后组织[KDIGO]标准定义）发生的AUC为0.733（0.701 - 0.765），AKI的连续NRI为56.9%。对于RRT，uNGAL24（95%CI）的AUC为0.839（0.797 - 0.880），NRI为56.3%。对于90天死亡率，uNGAL24（95%CI）的AUC为0.634（0.593至0.675），NRI为15.3%。RRT的LR+（95%CI）为3.81（3.26 - 4.47）。