Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland State University, Department of Mathematics, Cleveland, Ohio.
JACC Heart Fail. 2015 Oct;3(10):777-85. doi: 10.1016/j.jchf.2015.06.006.
This study sought to determine the relationship of KIM-1 levels with adverse clinical outcomes in acute decompensated heart failure (ADHF).
Kidney injury molecule (KIM)-1 is a biomarker expressed by the nephron in acute tubular injury, and is a sensitive and specific marker for early acute kidney injury. Although commonly measured in urine, KIM-1 levels are also detectable in plasma, but its clinical and prognostic utility in ADHF is unknown.
Baseline, 48- to 72-h, and 30-day KIM-1 plasma levels were measured in 874 subjects in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial. Multivariable logistic and Cox models were used to assess the relationship between KIM-1 levels and outcomes during and after ADHF.
The median circulating KIM-1 level at baseline was 375.4 pg/ml (interquartile range [IQR]: 237.0 to 633.1 pg/ml), at 48 to 72 h was 373.7 pg/ml (IQR: 220.3 to 640.5 pg/ml), and at 30 days was 382.6 pg/ml (IQR: 236.5 to 638.0 pg/ml). There were no associations between KIM-1 levels and any 30-day outcomes. In univariable analysis, both baseline and follow-up KIM-1 were associated with greater 180-day mortality risk. However, after adjusting for blood urea nitrogen or creatinine in addition to established risk predictors from ASCEND-HF, higher KIM-1 at all time points during hospitalization was not associated with in-hospital or post-discharge outcomes (all p > 0.05), but KIM-1 levels measured at 30 days were associated independently with 180-day mortality (hazard ratio: 1.49; p = 0.04).
In our study cohort, circulating KIM-1 at baseline and during hospitalization was not associated with adverse clinical outcomes in ADHF after adjusting for standard indices of kidney function.
本研究旨在确定肾损伤分子-1（KIM-1）水平与急性失代偿性心力衰竭（ADHF）不良临床结局的关系。
肾损伤分子（KIM）-1 是肾小管急性损伤时表达的一种生物标志物，是早期急性肾损伤的敏感和特异性标志物。虽然通常在尿液中测量，但 KIM-1 水平也可在血浆中检测到，但它在 ADHF 中的临床和预后应用尚不清楚。
在 ASCEND-HF（急性心力衰竭中奈西立肽临床疗效的研究）试验中，对 874 例患者进行了基线、48 至 72 小时和 30 天的 KIM-1 血浆水平测量。多变量逻辑和 Cox 模型用于评估 KIM-1 水平与 ADHF 期间和之后结局之间的关系。
基线时循环 KIM-1 中位数为 375.4pg/ml（四分位距[IQR]：237.0 至 633.1pg/ml），48 至 72 小时时为 373.7pg/ml（IQR：220.3 至 640.5pg/ml），30 天时为 382.6pg/ml（IQR：236.5 至 638.0pg/ml）。KIM-1 水平与任何 30 天结局均无关联。在单变量分析中，基线和随访时的 KIM-1 均与更高的 180 天死亡率风险相关。然而，在校正 ASCEND-HF 中的除血尿素氮或肌酐以外的其他既定风险预测因素后，住院期间所有时间点的 KIM-1 升高均与住院期间或出院后结局无关（均 p>0.05），但 30 天时的 KIM-1 水平与 180 天死亡率独立相关（危险比：1.49；p=0.04）。
在我们的研究队列中，在校正标准肾功能指标后，ADHF 患者的基线和住院期间的循环 KIM-1 与不良临床结局无关。
