Albeladi Fatma I, Algethamy Haifa M
Department of Nephrology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Critical Care Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Nephron Extra. 2017 Jul 12;7(2):62-77. doi: 10.1159/000477469. eCollection 2017 May-Aug.
Recent attempts were made to identify early indicators of acute kidney injury (AKI) in order to accelerate treatment and hopefully improve outcomes. This study aims to assess the value of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a predictor of AKI, severe AKI, and the need for renal replacement therapy (RRT).
We conducted a prospective study and included adults admitted to our intensive care unit (ICU) at King Abdulaziz University Hospital (KAUH), between May 2012 and June 2013, who had at least 1 major risk factor for AKI. They were followed up throughout their hospital stay to identify which potential characteristics predicted any of the above 3 outcomes. We collected information on patients' age and gender, the Acute Physiology And Chronic Health Evaluation, version II (APACHE II) score, the Sepsis-Related Organ Failure Assessment (SOFA) score, serum creatinine and cystatin C levels, and uNGAL. We compared ICU patients who presented with any of the 3 outcomes with others who did not.
We included 75 patients, and among those 21 developed AKI, 18 severe AKI, and 17 required RRT. Bivariate analysis revealed intergroup differences for almost all clinical variables (e.g., patients with AKI vs. patients without AKI); while multivariate analysis identified mean arterial pressure as the only predictor for AKI ( < 0.001) and the SOFA score ( = 0.04) as the only predictor for severe AKI. For RRT, day 1 maximum uNGAL was the stronger predictor ( < 0.001) when compared to admission diagnosis ( = 0.014). Day 1 and day 2 maximum uNGAL levels were good and excellent predictors for future RRT, but only fair to good predictors for AKI and severe AKI.
Maximum urine levels of uNGAL measured over the first and second 24 h of an ICU admission were highly accurate predictors of the future need for RRT, however less accurate at detecting early and severe AKI.
近期人们试图确定急性肾损伤（AKI）的早期指标，以便加快治疗并有望改善预后。本研究旨在评估尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）作为AKI、重度AKI及肾脏替代治疗（RRT）需求预测指标的价值。
我们进行了一项前瞻性研究，纳入了2012年5月至2013年6月期间入住阿卜杜勒阿齐兹国王大学医院（KAUH）重症监护病房（ICU）且至少有1项AKI主要危险因素的成年人。在他们住院期间进行随访，以确定哪些潜在特征可预测上述3种结局中的任何一种。我们收集了患者的年龄、性别、急性生理与慢性健康状况评估Ⅱ（APACHEⅡ）评分、脓毒症相关器官功能衰竭评估（SOFA）评分、血清肌酐和胱抑素C水平以及uNGAL。我们将出现上述3种结局之一的ICU患者与未出现的患者进行了比较。
我们纳入了75例患者，其中21例发生AKI，18例发生重度AKI，17例需要RRT。双变量分析显示几乎所有临床变量在组间存在差异（例如，发生AKI的患者与未发生AKI的患者）；而多变量分析确定平均动脉压是AKI的唯一预测指标（<0.001），SOFA评分是重度AKI的唯一预测指标（=0.04）。对于RRT，与入院诊断（=
