Lee Dong Hun, Lee Byung Kook, Cho Yong Soo, Jung Yong Hun, Lee Sung Min, Park Jung Soo, Jeung Kyung Woon
1 Department of Emergency Medicine, Chonnam National University Hospital , Gwangju, Republic of Korea.
2 Department of Emergency Medicine, Chungbuk National University Hospital , Cheongju, Republic of Korea.
Ther Hypothermia Temp Manag. 2018 Jun;8(2):99-107. doi: 10.1089/ther.2017.0039. Epub 2017 Nov 13.
Early diagnosis of acute kidney injury (AKI) after cardiac arrest (CA) is challenging. We aimed to identify the diagnostic and prognostic performance of neutrophil gelatinase-associated lipocalin (NGAL) for AKI and its clinical outcomes. A retrospective observational study, involving adult comatose CA survivors treated with therapeutic hypothermia between May 2013 and December 2016, was conducted. AKI was classified according to the guidelines of Kidney Disease Improving Global Outcomes. NGAL levels were measured after return of spontaneous circulation (ROSC). The primary outcome was development of AKI within 7 days after CA, and the secondary outcome was inhospital mortality. The study included 279 patients, of which 111 (39.8%) developed AKI and 61 (21.9%) died. Thirty-seven (33.3%) of patients in the AKI group had stage 3 AKI, and 45 (40.5%) patients received renal replacement therapy. The area under the curve of NGAL levels for diagnosing AKI was 0.725 (95% confidence interval [CI] 0.668-0.776), and NGAL levels were independently associated with the development of AKI (odds ratio [OR] 1.004; 95% CI 1.002-1.006). Nonsurvivors had significantly higher NGAL levels (221.0 ng/mL [154.0-355.5] vs. 148.5 ng/mL [97.0-232.9]; p < 0.001). The development of AKI was independently associated with mortality (OR 4.926; 95% CI 2.353-10.311); however, NGAL level was not associated with mortality (OR 1.000; 95% CI 0.999-1.001). Plasma NGAL level measured after ROSC can be an early predictor for the development of AKI after CA. The presence of AKI was associated with increased inhospital mortality.
心脏骤停（CA）后急性肾损伤（AKI）的早期诊断具有挑战性。我们旨在确定中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对AKI的诊断和预后价值及其临床结局。我们进行了一项回顾性观察研究，纳入了2013年5月至2016年12月期间接受治疗性低温治疗的成年昏迷CA幸存者。AKI根据改善全球肾脏病预后组织的指南进行分类。在自主循环恢复（ROSC）后测量NGAL水平。主要结局是CA后7天内发生AKI，次要结局是住院死亡率。该研究纳入了279例患者，其中111例（39.8%）发生了AKI，61例（21.9%）死亡。AKI组中有37例（33.3%）患者为3期AKI，45例（40.5%）患者接受了肾脏替代治疗。NGAL水平诊断AKI的曲线下面积为0.725（95%置信区间[CI] 0.668 - 0.776），且NGAL水平与AKI的发生独立相关（比值比[OR] 1.004；95% CI 1.002 - 1.006）。非幸存者的NGAL水平显著更高（221.0 ng/mL [154.0 - 355.5] vs. 148.5 ng/mL [97.0 - 232.9]；p < 0.001）。AKI的发生与死亡率独立相关（OR 4.926；95% CI 2.353 - 10.311）；然而，NGAL水平与死亡率无关（OR 1.000；95% CI 0.999 - 1.001）。ROSC后测量的血浆NGAL水平可作为CA后AKI发生的早期预测指标。AKI的存在与住院死亡率增加相关。
