全血中性粒细胞明胶酶相关脂质运载蛋白可预测烧伤患者的急性肾损伤。
Whole blood neutrophil gelatinase-associated lipocalin predicts acute kidney injury in burn patients.
作者信息
Sen Soman, Godwin Zack R, Palmieri Tina, Greenhalgh David, Steele Amanda N, Tran Nam K
机构信息
Division of Burn Surgery, Department of Surgery, University of California Davis, Sacramento, California.
Department of Pathology, University of California Davis, Sacramento, California.
出版信息
J Surg Res. 2015 Jun 15;196(2):382-7. doi: 10.1016/j.jss.2015.03.033. Epub 2015 Mar 20.
BACKGROUND
Early detection of acute kidney injury (AKI) in severely burn-injured patients can help alter treatment to prevent progression to acute failure and reduce the need for renal replacement therapy. We hypothesized that whole blood neutrophil gelatinase-associated lipocalin (NGAL) will be increased in severely burn-injured patients who develop AKI during acute resuscitation.
MATERIALS AND METHODS
We performed a prospective observation study of adult burn patients with a 20% total body surface area (TBSA) burned or greater burn injury. Two-hour serial measurements of NGAL, serum creatinine (Cr), and hourly urine output (UO) were collected for 48 h after admission. Our primary goal was to correlate the risk of AKI in the first week after burn injury with serial NGAL levels in the first 48 h after admission. Our secondary goal was to determine if NGAL was an earlier independent predictor of AKI compared with Cr and UO.
RESULTS
We enrolled 30 adult (age ≥ 18 y) burn patients with the mean ± standard deviation age of 40.9 ± 15.4 and mean TBSA of 46.4 ± 22.4. Fourteen patients developed AKI within the first 7 d after burn injury. There were no differences in age, TBSA, fluid administration, mean arterial pressure, UO, and Cr between AKI and no-AKI patients. NGAL was significantly increased as early as 4 h after injury (182.67 ± 83.3 versus 107.37 ± 46.15) in the AKI group. Controlling for age, TBSA, and inhalation injury, NGAL was a predictor of AKI at 4 h after injury (odds ratio, 1.02) and remained predictive of AKI for the period of more than the first 24 h after admission. UO and Cr were not predictive of AKI in the first 24 h after admission.
CONCLUSIONS
Whole blood NGAL is markedly increased in burn patients who develop AKI in the first week after injury. In addition, NGAL is an early independent predictor of AKI during acute resuscitation for severe burn injury. UO and Cr are not predictive of AKI during this time period.
背景
早期发现严重烧伤患者的急性肾损伤（AKI）有助于改变治疗方案，以防止病情进展至急性肾衰竭，并减少肾脏替代治疗的需求。我们推测，在急性复苏期间发生AKI的严重烧伤患者中，全血中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平会升高。
材料与方法
我们对成年烧伤患者进行了一项前瞻性观察研究，这些患者的烧伤总面积（TBSA）达到20%或更高。入院后48小时内，每两小时连续测量一次NGAL、血清肌酐（Cr）和每小时尿量（UO）。我们的主要目标是将烧伤后第一周内发生AKI的风险与入院后最初48小时内的连续NGAL水平相关联。我们的次要目标是确定与Cr和UO相比，NGAL是否是AKI的更早独立预测指标。
结果
我们纳入了30名成年（年龄≥18岁）烧伤患者，平均年龄±标准差为40.9±15.4岁，平均TBSA为46.4±22.4。14名患者在烧伤后7天内发生了AKI。AKI患者和未发生AKI患者在年龄、TBSA、液体输注量、平均动脉压、UO和Cr方面没有差异。在AKI组中，受伤后4小时NGAL就显著升高（182.67±83.3对107.37±46.15）。在控制年龄、TBSA和吸入性损伤后，受伤后4小时NGAL是AKI的预测指标（比值比，1.02），并且在入院后超过24小时的时间段内仍然是AKI的预测指标。入院后最初24小时内，UO和Cr不是AKI的预测指标。
结论
在受伤后第一周发生AKI的烧伤患者中，全血NGAL显著升高。此外，在严重烧伤的急性复苏期间，NGAL是AKI的早期独立预测指标。在此时间段内，UO和Cr不是AKI的预测指标。
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