Ralib Azrina Md, Pickering John W, Shaw Geoffrey M, Than Martin P, George Peter M, Endre Zoltán H
Department of Anaesthesiology and Intensive Care, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Crit Care. 2014 Nov 4;18(6):601. doi: 10.1186/s13054-014-0601-2.
Acute Kidney Injury (AKI) biomarker utility depends on sample timing after the onset of renal injury. We compared biomarker performance on arrival in the emergency department (ED) with subsequent performance in the intensive care unit (ICU).
Urinary and plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL), and urinary Cystatin C (CysC), alkaline phosphatase, γ-Glutamyl Transpeptidase (GGT), α- and π-Glutathione S-Transferase (GST), and albumin were measured on ED presentation, and at 0, 4, 8, and 16 hours, and days 2, 4 and 7 in the ICU in patients after cardiac arrest, sustained or profound hypotension or ruptured abdominal aortic aneurysm. AKI was defined as plasma creatinine increase ≥ 26.5 μmol/l within 48 hours or ≥ 50% within 7 days.
In total, 45 of 77 patients developed AKI. Most AKI patients had elevated urinary NGAL, and plasma NGAL and CysC in the period 6 to 24 hours post presentation. Biomarker performance in the ICU was similar or better than when measured earlier in the ED. Plasma NGAL diagnosed AKI at all sampling times, urinary NGAL, plasma and urinary CysC up to 48 hours, GGT 4 to 12 hours, and π-GST 8 to 12 hours post insult. Thirty-one patients died or required dialysis. Peak 24-hour urinary NGAL and albumin independently predicted 30-day mortality and dialysis; odds ratios 2.87 (1.32 to 6.26), and 2.72 (1.14 to 6.48), respectively. Urinary NGAL improved risk prediction by 11% (IDI event of 0.06 (0.002 to 0.19) and IDI non-event of 0.04 (0.002 to 0.12)).
Early measurement in the ED has utility, but not better AKI diagnostic performance than later ICU measurement. Plasma NGAL diagnosed AKI at all time points. Urinary NGAL best predicted mortality or dialysis compared to other biomarkers.
Australian and New Zealand Clinical Trials Registry ACTRN12610001012066. Registered 12 February 2010.
急性肾损伤(AKI)生物标志物的效用取决于肾损伤发作后的样本采集时间。我们比较了患者在急诊科(ED)就诊时生物标志物的表现与随后在重症监护病房(ICU)中的表现。
对心脏骤停、持续性或严重低血压或腹主动脉瘤破裂患者,在急诊科就诊时以及在重症监护病房的0、4、8和16小时,以及第2、4和7天测量尿液和血浆中的中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿液胱抑素C(CysC)、碱性磷酸酶、γ-谷氨酰转肽酶(GGT)、α-和π-谷胱甘肽S-转移酶(GST)以及白蛋白。AKI定义为血浆肌酐在48小时内升高≥26.5μmol/l或在7天内升高≥50%。
77例患者中共有45例发生AKI。大多数AKI患者在就诊后6至24小时内尿液NGAL、血浆NGAL和CysC升高。生物标志物在重症监护病房的表现与在急诊科早期测量时相似或更好。血浆NGAL在所有采样时间均可诊断AKI,尿液NGAL、血浆和尿液CysC在损伤后48小时内,GGT在4至12小时,π-GST在8至12小时可诊断AKI。31例患者死亡或需要透析。24小时尿液NGAL和白蛋白峰值独立预测30天死亡率和透析;优势比分别为2.87(1.32至6.26)和2.72(1.14至6.48)。尿液NGAL将风险预测提高了11%(事件的综合判别指数为0.06(0.002至0.19),非事件的综合判别指数为0.04(0.002至0.12))。
在急诊科进行早期测量有一定作用,但在AKI诊断性能上并不比在重症监护病房后期测量更好。血浆NGAL在所有时间点均可诊断AKI。与其他生物标志物相比,尿液NGAL对死亡率或透析的预测效果最佳。
澳大利亚和新西兰临床试验注册中心ACTRN12610001012066。2010年2月12日注册。