de Geus Hilde R H, Ronco Claudio, Haase Michael, Jacob Laurent, Lewington Andrew, Vincent Jean-Louis
Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
J Thorac Cardiovasc Surg. 2016 Jun;151(6):1476-81. doi: 10.1016/j.jtcvs.2016.01.037. Epub 2016 Feb 12.
Acute kidney injury (AKI), defined as a rise in serum creatinine (functional AKI), is a frequent complication after cardiac surgery. The expression pattern of acute tubular damage biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) has been shown to precede functional AKI and, therefore, may be useful to identify very early tubular damage. The term subclinical AKI represents acute tubular damage in the absence of functional AKI (biomarker positivity without a rise in serum creatinine) and affects hard outcome measures. This potentiates an tubular-damage-based identification of renal injury, which may guide clinical management, allowing for very early preventive-protective strategies. The aim of this paper was to review the current available evidence on NGAL applicability in adult cardiac surgery patients and combine this knowledge with the expert consensus of the authors to generate an NGAL based tubular damage score: The cardiac surgery-associated NGAL Score (CSA-NGAL score). The CSA-NGAL score might be the tool needed to improve awareness and enable interventions to possibly modify these detrimental outcomes. In boldly doing so, it is intended to introduce a different approach in study designs, which will undoubtedly expand our knowledge and will hopefully move the AKI biomarker field forward.
急性肾损伤（AKI）定义为血清肌酐升高（功能性AKI），是心脏手术后常见的并发症。诸如中性粒细胞明胶酶相关脂质运载蛋白（NGAL）等急性肾小管损伤生物标志物的表达模式已被证明先于功能性AKI出现，因此，可能有助于识别极早期的肾小管损伤。亚临床AKI一词代表在无功能性AKI情况下的急性肾小管损伤（生物标志物阳性但血清肌酐未升高），并影响严重结局指标。这增强了基于肾小管损伤的肾损伤识别，这可能指导临床管理，从而实现极早期的预防保护策略。本文的目的是回顾目前关于NGAL在成人心脏手术患者中适用性的现有证据，并将这些知识与作者的专家共识相结合，以生成基于NGAL的肾小管损伤评分：心脏手术相关NGAL评分（CSA-NGAL评分）。CSA-NGAL评分可能是提高认识并使干预措施能够改变这些有害结局所需的工具。在大胆这样做的过程中，旨在引入一种不同的研究设计方法，这无疑将扩展我们的知识，并有望推动AKI生物标志物领域向前发展。
