Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.
Department of Critical Care Medicine, Xiaolan Hospital of Southern Medical University, 65 Jucheng Road, Zhongshan, 528415, Guangdong, People's Republic of China.
Crit Care. 2017 Mar 7;21(1):46. doi: 10.1186/s13054-017-1626-0.
Although serum cystatin C (sCysC), urinary N-acetyl-β-D-glucosaminidase (uNAG), and urinary albumin/creatinine ratio (uACR) are clinically available, their optimal combination for acute kidney injury (AKI) detection and prognosis prediction remains unclear. We aimed to assess the discriminative abilities of these biomarkers and their possible combinations for AKI detection and intensive care unit (ICU) mortality prediction in critically ill adults.
A multicenter, prospective observational study was conducted in mixed medical-surgical ICUs at three tertiary care hospitals. One thousand eighty-four adult critically ill patients admitted to the ICUs were studied. We assessed the use of individual biomarkers (sCysC, uNAG, and uACR) measured at ICU admission and their combinations with regard to AKI detection and prognosis prediction.
AUC-ROCs for sCysC, uNAG, and uACR were calculated for total AKI (0.738, 0.650, and 0.683, respectively), severe AKI (0.839, 0.706, and 0.771, respectively), and ICU mortality (0.727, 0.793, and 0.777, respectively). The panel of sCysC plus uNAG detected total and severe AKI with significantly higher accuracy than either individual biomarkers or the other two panels (uNAG plus uACR or sCysC plus uACR). For detecting total AKI, severe AKI, and ICU mortality at ICU admission, this panel yielded AUC-ROCs of 0.756, 0.863, and 0.811, respectively; positive predictive values of 0.71, 0.31, and 0.17, respectively; and negative predictive values of 0.81, 0.97, and 0.98, respectively. Moreover, this panel significantly contributed to the accuracy of the clinical models for AKI detection and ICU mortality prediction, as measured by the AUC-ROC, continuous net reclassification index, and incremental discrimination improvement index. The comparable performance of this panel was further confirmed with bootstrap internal validation.
The combination of a functional marker (sCysC) and a tubular damage marker (uNAG) revealed significantly superior discriminative performance for AKI detection and yielded additional prognostic information on ICU mortality.
血清胱抑素 C（sCysC）、尿 N-乙酰-β-D-氨基葡萄糖苷酶（uNAG）和尿白蛋白/肌酐比值（uACR）在临床上均可获得，但用于检测急性肾损伤（AKI）和预测预后的最佳组合尚不清楚。本研究旨在评估这些生物标志物及其组合对重症成人 AKI 检测和重症监护病房（ICU）死亡率预测的鉴别能力。
在三家三级医院的混合内科-外科 ICU 中进行了一项多中心前瞻性观察性研究。对入住 ICU 的 1084 名成年危重症患者进行了研究。我们评估了 ICU 入院时测定的单个生物标志物（sCysC、uNAG 和 uACR）及其组合对 AKI 检测和预后预测的作用。
sCysC、uNAG 和 uACR 的 AUC-ROC 分别用于总 AKI（0.738、0.650 和 0.683）、严重 AKI（0.839、0.706 和 0.771）和 ICU 死亡率（0.727、0.793 和 0.777）。sCysC 加 uNAG 联合检测可显著提高总 AKI 和严重 AKI 的检测准确性，优于任何单个标志物或其他两种联合检测（uNAG 加 uACR 或 sCysC 加 uACR）。对于检测 ICU 入住时的总 AKI、严重 AKI 和 ICU 死亡率，该联合检测的 AUC-ROC 分别为 0.756、0.863 和 0.811，阳性预测值分别为 0.71、0.31 和 0.17，阴性预测值分别为 0.81、0.97 和 0.98。此外，该联合检测还显著提高了 AKI 检测和 ICU 死亡率预测的临床模型准确性，其 AUC-ROC、连续净重新分类指数和增量判别改善指数均有所提高。Bootstrap 内部验证进一步证实了该联合检测的可比性能。
功能标志物（sCysC）和管损伤标志物（uNAG）的联合检测对 AKI 的检测具有显著的鉴别性能，并能提供 ICU 死亡率的额外预后信息。
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