Taghizadeh-Ghehi Maryam, Sarayani Amir, Ashouri Asieh, Ataei Sara, Moslehi Amirhossein, Hadjibabaie Molouk
a Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran , Iran .
b Department of Epidemiology and Biostatistics , School of Public Health, Tehran University of Medical Sciences , Tehran , Iran , and.
Ren Fail. 2015 Jul;37(6):994-8. doi: 10.3109/0886022X.2015.1040699. Epub 2015 May 6.
Acute kidney injury (AKI) is common in hematopoietic stem cell transplantation (HSCT) patients with an incidence of 21-73%. Prevention and early diagnosis reduces the frequency and severity of this complication. Predictive biomarkers are of major importance to timely diagnosis. Neutrophil gelatinase associated lipocalin (NGAL) is a widely investigated novel biomarker for early diagnosis of AKI. However, no study assessed NGAL for AKI diagnosis in HSCT patients. We performed further analyses on gathered data from our recent trial to evaluate the performance of urine NGAL (uNGAL) as an indicator of AKI in 72 allogeneic HSCT patients. AKI diagnosis and severity were assessed using Risk-Injury-Failure-Loss-End-stage renal disease and AKI Network criteria. We assessed uNGAL on days -6, -3, +3, +9 and +15. Time-dependent Cox regression analysis revealed a statistically significant relationship between uNGAL and AKI occurrence. (HR = 1.04 (1.008-1.07), p = 0.01). There was a relation between uNGAL day + 9 to baseline ratio and incidence of AKI (unadjusted HR = 1.047 (1.012-1.083), p < 0.01). The area under the receiver-operating characteristic curve for day + 9 to baseline ratio was 0.86 (0.74-0.99, p < 0.01) and a cut-off value of 2.62 was 85% sensitive and 83% specific in predicting AKI. Our results indicated that increase in uNGAL augmented the risk of AKI and the changes of day +9 uNGAL concentrations from baseline could be of value for predicting AKI in HSCT patients. Additionally uNGAL changes preceded serum Cr raises by nearly 2 days.
急性肾损伤（AKI）在造血干细胞移植（HSCT）患者中很常见，发病率为21%-73%。预防和早期诊断可降低这种并发症的发生频率和严重程度。预测性生物标志物对于及时诊断至关重要。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是一种被广泛研究的用于AKI早期诊断的新型生物标志物。然而，尚无研究评估NGAL在HSCT患者中对AKI的诊断价值。我们对近期试验收集的数据进行了进一步分析，以评估尿NGAL（uNGAL）作为72例异基因HSCT患者AKI指标的性能。使用风险-损伤-衰竭-丧失-终末期肾病和AKI网络标准评估AKI的诊断和严重程度。我们在第-6、-3、+3、+9和+15天评估uNGAL。时间依赖性Cox回归分析显示uNGAL与AKI发生之间存在统计学显著关系（HR = 1.04（1.008-1.07），p = 0.01）。uNGAL第+9天与基线的比值与AKI发生率之间存在关联（未调整HR = 1.047（1.012-1.083），p < 0.01）。第+9天与基线比值的受试者工作特征曲线下面积为0.86（0.74-0.99，p < 0.01），截断值为2.62时，预测AKI的敏感性为85%，特异性为83%。我们的结果表明，uNGAL升高会增加AKI的风险，第+9天uNGAL浓度相对于基线的变化可能对预测HSCT患者的AKI有价值。此外，uNGAL的变化比血清肌酐升高提前近2天。
