Mårtensson J, Vaara S T, Pettilä V, Ala-Kokko T, Karlsson S, Inkinen O, Uusaro A, Larsson A, Bell M
Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Intensive Care, Austin Hospital, Heidelberg, Vic., Australia.
Acta Anaesthesiol Scand. 2017 Nov;61(10):1286-1295. doi: 10.1111/aas.12988. Epub 2017 Aug 31.
We evaluated whether plasma endostatin predicts acute kidney injury (AKI), need for renal replacement therapy (RRT), or death.
Prospective, observational, multicenter study from 1 September 2011 to 1 February 2012 with data from 17 intensive care units (ICUs) in Finland.
A total of 1112 patients were analyzed. We measured plasma endostatin within 2 h of ICU admission. Early AKI (KDIGO stage within 12 h of ICU admission) was found in 20% of the cohort, and 18% developed late AKI (KDIGO criteria > 12 h from ICU admission). Median (IQR) admission endostatin was higher in the early AKI group, 29 (19.1, 41.9) ng/ml as compared to 22.4 (16.1, 30.1) ng/ml for the late AKI group, and 18 (14.0, 23.6) ng/ml for non-AKI patients (P < 0.001). Endostatin level increased with increasing KDIGO stage. Significantly higher endostatin levels were found in patients with sepsis as compared to those without. Predictive properties for AKI, RRT, and mortality were low with corresponding areas under the receiver operating characteristic curve (AUC) of 0.62, 0.67, and 0.59. Sensitivity analyses among patients with chronic kidney disease or sepsis did not improve the predictive ability of endostatin. Adding endostatin to a clinical AKI prediction model (illness severity score, urine output, and age) insignificantly changed the AUC from 0.67 to 0.70 (P = 0.14).
Endostatin increases with AKI severity but has limited value as a predictor of AKI, RRT and 90-day mortality in patients admitted to ICU. Moreover, endostatin does not improve AKI risk prediction when added to a clinical risk model.
我们评估了血浆内皮抑素是否可预测急性肾损伤（AKI）、肾脏替代治疗（RRT）需求或死亡情况。
2011年9月1日至2012年2月1日进行的前瞻性、观察性、多中心研究，数据来自芬兰的17个重症监护病房（ICU）。
共分析了1112例患者。我们在ICU入院后2小时内测定了血浆内皮抑素。20%的队列患者出现早期AKI（KDIGO分期在ICU入院后12小时内），18%的患者出现晚期AKI（KDIGO标准为ICU入院12小时后）。早期AKI组入院时内皮抑素的中位数（IQR）较高，为29（19.1，41.9）ng/ml，而晚期AKI组为22.4（16.1，30.1）ng/ml，非AKI患者为18（14.0，23.6）ng/ml（P<0.001）。内皮抑素水平随KDIGO分期增加而升高。与无脓毒症患者相比，脓毒症患者的内皮抑素水平显著更高。AKI、RRT和死亡率的预测性能较低，相应的受试者工作特征曲线（AUC）下面积分别为0.62、0.67和0.59。对慢性肾脏病或脓毒症患者进行的敏感性分析并未提高内皮抑素的预测能力。将内皮抑素添加到临床AKI预测模型（疾病严重程度评分、尿量和年龄）中，AUC从0.67略微变化至0.70（P = 0.14）。
内皮抑素水平随AKI严重程度增加，但作为ICU入院患者AKI、RRT和90天死亡率的预测指标，其价值有限。此外，将内皮抑素添加到临床风险模型中并不能改善AKI风险预测。
