Baron-Stefaniak Joanna, Schiefer Judith, Miller Edmund J, Berlakovich Gabriela A, Baron David M, Faybik Peter
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
The Feinstein Institute for Medical Research, Northwell Health System, Manhasset, New York, United States of America.
PLoS One. 2017 Aug 15;12(8):e0183162. doi: 10.1371/journal.pone.0183162. eCollection 2017.
Several biomarkers have been suggested as early predictors of acute kidney injury (AKI) after orthotopic liver transplantation (OLT). Neutrophil gelatinase-associated lipocalin-2 (NGAL) appears to be a promising predictor of AKI after OLT, but the clinical benefit remains to be proven. Recently, systemic macrophage migration inhibitory factor (MIF) has been proposed as early indicator for requirement of renal replacement therapy after OLT. The aim of this prospective, observational pilot study was to compare the predictive values of serum and urinary MIF for severe AKI after OLT to those of serum and urinary NGAL.
Concentrations of MIF and NGAL were measured in serum and urine samples collected from patients undergoing OLT. Acute kidney injury was classified according to the KDIGO criteria, with stages 2 and 3 summarized as severe AKI. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of MIF and NGAL for the development of severe AKI.
Forty-five patients (mean age 55±8 years) were included. Nineteen patients (38%) developed severe AKI within 48 hours after reperfusion. At the end of OLT, serum MIF was predictive of severe AKI (AUC 0.73; 95% confidence intervals, CI 0.55-0.90; P = 0.03), whereas urinary MIF, serum NGAL, and urinary NGAL were not. On the first postoperative day, serum MIF (AUC 0.78; CI 0.62-0.93; P = 0.006), urinary MIF (AUC 0.71; CI 0.53-0.88; P = 0.03), and urinary NGAL (AUC 0.79; CI 0.64-0.93; P = 0.02) were predictive for severe AKI, while serum NGAL was not.
In the setting of OLT, MIF and NGAL had similar predictive values for the development of severe AKI.
已有多种生物标志物被提出作为原位肝移植（OLT）后急性肾损伤（AKI）的早期预测指标。中性粒细胞明胶酶相关脂质运载蛋白-2（NGAL）似乎是OLT后AKI的一个有前景的预测指标，但临床益处仍有待证实。最近，全身性巨噬细胞移动抑制因子（MIF）已被提议作为OLT后需要肾脏替代治疗的早期指标。这项前瞻性观察性试点研究的目的是比较血清和尿MIF对OLT后严重AKI的预测价值与血清和尿NGAL的预测价值。
对接受OLT的患者采集的血清和尿液样本测量MIF和NGAL的浓度。根据KDIGO标准对急性肾损伤进行分类，将2期和3期合并为严重AKI。计算受试者工作曲线下面积（AUC）以评估MIF和NGAL对严重AKI发生的预测价值。
纳入45例患者（平均年龄55±8岁）。19例患者（38%）在再灌注后48小时内发生严重AKI。在OLT结束时，血清MIF可预测严重AKI（AUC 0.73；95%置信区间，CI 0.55 - 0.90；P = 0.03），而尿MIF、血清NGAL和尿NGAL则不能。术后第1天，血清MIF（AUC 0.78；CI 0.62 - 0.93；P = 0.006）、尿MIF（AUC 0.71；CI 0.53 - 0.88；P = 0.03）和尿NGAL（AUC 0.79；CI 0.64 - 0.93；P = 0.02）可预测严重AKI，而血清NGAL则不能。
在OLT情况下，MIF和NGAL对严重AKI发生的预测价值相似。
