Menzorov M V, Shutov A M, Midlenko V I, Larionova N V, Morozova I V, Akulova O V
Ulyanovsk State University, Ulyanovsk, Russia.
Ter Arkh. 2017;89(3):78-84. doi: 10.17116/terarkh201789378-84.
To investigate the prognostic value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in the development of acute kidney injury (AKI) in patients with acute decompensated chronic heart failure (ADCHF).
Eighty-three patients (55 (66%) men and 28 (34%) women; mean age, 65±11 years) with ADCHF were examined. AKI was diagnosed and classified according to the 2012 Kidney Disease Improving Global Outcomes Clinical Practice guidelines. To rule out contrast-induced AKI, the investigation enrolled only patients in whom radiopague agents had not been injected 7 days before and during hospitalization. Enzyme immunoassay was used to determine serum NT-proBNP concentrations in all the patients upon hospital admission.
AKI was diagnosed in 18 (22%) patients, 13 (16%) had Stage I, 4 (5%) had Stage II, and 1 (1%) had Stage III. The serum concentration of NT-proBNP was significantly higher in patients with AKI than that in the other patients [1512.1 (981.0; 2246.2) and 861.8 (499.0; 1383.6) pg/ml (p=0.008). The rise in NT-proBNP concentrations of more than 942 pg/ml was established to be associated with a considerable increase in the risk of AKI (relative risk (RR) was 4.3; 95% confidence interval (CI), 1.27-14.90; p=0.02). RОС analysis indicated that a NT-proBNP level of >942 pg/ml allows prediction of AKI with a sensitivity of 78% (52; 94) and a specificity of 55% (44; 69) (AUC=0.70; p=0.006). Four (5%) patients died in hospital. NT-proBNP levels in all the dead were greater than 942 pg/ml. Two of the 4 deceased patients had AKI.
A high level of NT-proBNP in a patient with ADCHF during hospitalization can serve as a biomarker for high risk of AKI and for high mortality rates.
探讨血清N末端脑钠肽前体（NT-proBNP）对急性失代偿性慢性心力衰竭（ADCHF）患者急性肾损伤（AKI）发生发展的预后价值。
对83例ADCHF患者（55例（66%）男性，28例（34%）女性；平均年龄65±11岁）进行检查。根据2012年改善全球肾脏病预后组织（KDIGO）临床实践指南诊断并分类AKI。为排除造影剂所致AKI，本研究仅纳入在住院前7天及住院期间未注射造影剂的患者。采用酶免疫法测定所有患者入院时血清NT-proBNP浓度。
18例（22%）患者诊断为AKI，其中13例（16%）为Ⅰ期，4例（5%）为Ⅱ期，1例（1%）为Ⅲ期。AKI患者血清NT-proBNP浓度显著高于其他患者[分别为1512.1（981.0；2246.2）和861.8（499.0；1383.6）pg/ml（p = 0.008）]。NT-proBNP浓度升高超过942 pg/ml与AKI风险显著增加相关（相对风险（RR）为4.3；95%置信区间（CI）为1.27 - 14.90；p = 0.02）。ROC分析表明，NT-proBNP水平>942 pg/ml预测AKI的敏感性为78%（52；94），特异性为55%（44；69）（曲线下面积（AUC）= 0.70；p = 0.006）。4例（5%）患者在医院死亡。所有死亡患者的NT-proBNP水平均大于942 pg/ml。4例死亡患者中有2例发生AKI。
ADCHF患者住院期间NT-proBNP水平升高可作为AKI高风险和高死亡率的生物标志物。
