Singer Eugenia, Schrezenmeier Eva V, Elger Antje, Seelow Evelyn R, Krannich Alexander, Luft Friedrich C, Schmidt-Ott Kai M
Department of Nephrology, Charité─Universitätsmedizin Berlin, Berlin, Germany.
Max Delbrück Center for Molecular Medicine, Berlin, Germany.
Kidney Int Rep. 2016 Jul 25;1(3):114-124. doi: 10.1016/j.ekir.2016.07.003. eCollection 2016 Sep.
Neutrophil gelatinase-associated lipocalin (NGAL) is a widely studied biomarker of renal tubular injury. Urinary NGAL (uNGAL) during acute kidney injury (AKI) predicts short-term adverse outcomes. However, the long-term predictive value is unknown.
We performed a prospective observational study of 145 patients with hospital-acquired AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria and analyzed the long-term predictive value of uNGAL at the time of AKI. We defined a composite outcome of all-cause mortality and the development of end-stage renal disease (ESRD).
In all, 61 AKI patients died and 22 developed ESRD within 6 months. The uNGAL levels were significantly higher in patients with poor long-term outcomes. uNGAL levels ≥362 μg/l (highest quartile) and uNGAL levels between 95 and 362 μg/l (third quartile) were associated with hazard ratios of 3.7 (95% confidence interval, 2.1-6.5) and 1.9 (1.1-3.5), respectively, compared with uNGAL levels <95 μg/l (lower quartiles). After 6 months, 67% and 43% of patients within the highest and third uNGAL quartile, respectively, had either progressed to ESRD or died, compared to only 21% of patients with uNGAL in the lower 2 quartiles ( < 0.001). In multivariable Cox regression analyses accounting for conventional predictors, uNGAL was the strongest independent predictor of adverse long-term outcomes. The association of uNGAL levels and poor long-term outcomes remained significant in the subgroup of 107 AKI survivors discharged without requiring dialysis ( = 0.002).
These data indicate that elevated uNGAL levels at AKI diagnosis predict poor long-term outcomes.
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是一种被广泛研究的肾小管损伤生物标志物。急性肾损伤（AKI）期间的尿NGAL（uNGAL）可预测短期不良结局。然而，其长期预测价值尚不清楚。
我们根据风险、损伤、衰竭、肾功能丧失和终末期肾病（RIFLE）标准，对145例医院获得性AKI患者进行了一项前瞻性观察研究，并分析了AKI时uNGAL的长期预测价值。我们定义了全因死亡率和终末期肾病（ESRD）发生的综合结局。
总共有61例AKI患者在6个月内死亡，22例发展为ESRD。长期预后不良的患者uNGAL水平显著更高。与uNGAL水平<95μg/l（较低四分位数）相比，uNGAL水平≥362μg/l（最高四分位数）和uNGAL水平在95至362μg/l之间（第三四分位数）的风险比分别为3.7（95%置信区间，2.1 - 6.5）和1.9（1.1 - 3.5）。6个月后，uNGAL最高四分位数组和第三四分位数组分别有67%和43%的患者进展为ESRD或死亡，而uNGAL处于较低两个四分位数（<95μg/l）的患者中这一比例仅为21%（P<0.001）。在考虑传统预测因素的多变量Cox回归分析中，uNGAL是长期不良结局的最强独立预测因素。在107例无需透析出院的AKI幸存者亚组中，uNGAL水平与不良长期结局之间的关联仍然显著（P = 0.002）。
这些数据表明，AKI诊断时uNGAL水平升高预示着长期预后不良。
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