Schaub Jennifer A, Garg Amit X, Coca Steven G, Testani Jeffrey M, Shlipak Michael G, Eikelboom John, Kavsak Peter, McArthur Eric, Shortt Colleen, Whitlock Richard, Parikh Chirag R
Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA.
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
Kidney Int. 2015 Sep;88(3):576-83. doi: 10.1038/ki.2015.104. Epub 2015 Apr 1.
Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Since heart fatty acid binding protein (H-FABP) is a myocardial protein that detects cardiac injury, we sought to determine whether plasma H-FABP was associated with AKI in the TRIBE-AKI cohort; a multi-center cohort of 1219 patients at high risk for AKI who underwent cardiac surgery. The primary outcomes of interest were any AKI (Acute Kidney Injury Network (AKIN) stage 1 or higher) and severe AKI (AKIN stage 2 or higher). The secondary outcome was long-term mortality after discharge. Patients who developed AKI had higher levels of H-FABP pre- and postoperatively than patients who did not have AKI. In analyses adjusted for known AKI risk factors, first postoperative log(H-FABP) was associated with severe AKI (adjusted odds ratio (OR) 5.39 (95% confidence interval (CI), 2.87-10.11) per unit increase), while preoperative log(H-FABP) was associated with any AKI (2.07 (1.48-2.89)) and mortality (1.67 (1.17-2.37)). These relationships persisted after adjustment for change in serum creatinine (for first postoperative log(H-FABP)) and biomarkers of cardiac and kidney injury, including brain natriuretic peptide, cardiac troponin-I, interleukin-18, liver fatty acid binding protein, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin. Thus, perioperative plasma H-FABP levels may be used for risk stratification of AKI and mortality following cardiac surgery.
急性肾损伤（AKI）是心脏手术后常见的并发症，且与更差的预后相关。由于心脏脂肪酸结合蛋白（H-FABP）是一种可检测心脏损伤的心肌蛋白，我们试图确定在TRIBE-AKI队列中，血浆H-FABP是否与AKI相关；该队列是一个多中心队列，由1219例接受心脏手术且有AKI高风险的患者组成。感兴趣的主要结局是任何AKI（急性肾损伤网络（AKIN）1期或更高分期）和严重AKI（AKIN 2期或更高分期）。次要结局是出院后的长期死亡率。发生AKI的患者术前和术后的H-FABP水平均高于未发生AKI的患者。在对已知的AKI危险因素进行校正的分析中，术后首次log（H-FABP）与严重AKI相关（每单位增加的校正比值比（OR）为5.39（95%置信区间（CI），2.87-10.11）），而术前log（H-FABP）与任何AKI（2.07（1.48-2.89））和死亡率（1.67（1.17-2.37））相关。在校正血清肌酐变化（针对术后首次log（H-FABP））以及心脏和肾脏损伤的生物标志物（包括脑钠肽、心肌肌钙蛋白I、白细胞介素-18、肝脏脂肪酸结合蛋白、肾损伤分子-1和中性粒细胞明胶酶相关脂质运载蛋白）后，这些关系依然存在。因此，围手术期血浆H-FABP水平可用于心脏手术后AKI和死亡率的风险分层。
