Fuernau Georg, Poenisch Christian, Eitel Ingo, Denks Daniel, de Waha Suzanne, Pöss Janine, Heine Gunnar H, Desch Steffen, Schuler Gerhard, Adams Volker, Werdan Karl, Zeymer Uwe, Thiele Holger
Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
Int J Cardiol. 2015 Jul 15;191:159-66. doi: 10.1016/j.ijcard.2015.04.242. Epub 2015 May 1.
In cardiogenic shock (CS) renal dysfunction is an important parameter of inadequate end-organ perfusion and an independent predictor of adverse outcome. Early detection of renal dysfunction is therefore important, and novel biomarkers such as Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM1) and Cystatin C (CysC) have been suggested. However, in high-risk CS patients their role for assessing renal injury has not yet been investigated in comparison to the most widely used serum creatinine.
This predefined substudy included 190 patients of the randomized Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II)-trial. Blood samples were collected directly during primary percutaneous coronary intervention, one day and two days after randomization. The primary endpoint for outcome assessment was 1 year mortality.
Creatinine, NGAL and KIM-1 were significantly higher in non-survivors in comparison to survivors over time in ANOVA (p<0.001; p=0.002 and p=0.04, respectively). In contrast, CysC levels were not associated with the primary endpoint (p=0.15). Receiver operator characteristics revealed that creatinine at any time point had the best predictive value for 1 year mortality. This was also true when comparing creatinine to different equations for glomerular filtration rate. In multivariable Cox-regression analysis creatinine remained the only significant independent predictor of kidney biomarkers of time to death during the first year.
Assessment of novel biomarkers such as CysC, NGAL and KIM-1 or calculation of glomerular filtration rate provide no additional prognostic information in patients with CS complicating acute myocardial infarction in comparison to creatinine.
在心源性休克（CS）中，肾功能不全是终末器官灌注不足的重要指标，也是不良预后的独立预测因素。因此，早期发现肾功能不全很重要，有人提出了诸如中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子1（KIM1）和胱抑素C（CysC）等新型生物标志物。然而，在高危CS患者中，与最常用的血清肌酐相比，它们在评估肾损伤方面的作用尚未得到研究。
这项预先设定的亚研究纳入了190例随机接受心源性休克II期主动脉内球囊反搏（IABP-SHOCK II）试验的患者。在初次经皮冠状动脉介入治疗期间、随机分组后一天和两天直接采集血样。评估预后的主要终点是1年死亡率。
在方差分析中，随着时间的推移，非幸存者的肌酐、NGAL和KIM-1显著高于幸存者（分别为p<0.001；p=0.002和p=0.04）。相比之下，CysC水平与主要终点无关（p=0.15）。受试者工作特征曲线显示，任何时间点的肌酐对1年死亡率的预测价值最佳。将肌酐与不同的肾小球滤过率方程进行比较时也是如此。在多变量Cox回归分析中，肌酐仍然是第一年死亡时间肾生物标志物的唯一显著独立预测因素。
与肌酐相比，评估CysC、NGAL和KIM-1等新型生物标志物或计算肾小球滤过率，在合并急性心肌梗死的CS患者中不能提供额外的预后信息。
