Tyagi Asha, Lahan Shubham, Verma Gaurav, Das Shukla, Kumar Mahendra
Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, New Delhi, India.
Indian J Crit Care Med. 2018 Aug;22(8):602-607. doi: 10.4103/ijccm.IJCCM_170_18.
This prospective cohort study evaluated intra-abdominal pressure (IAP) and its role in causing acute kidney injury (AKI) in critically ill obstetric patients and utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI.
A total of 50 eligible obstetric patients admitted to our Intensive Care Unit were enrolled and daily IAP measured using indwelling Foley catheter. Early AKI was diagnosed as per the KDIGO criteria and urine assessed for NGAL using ELISA.
AKI was seen in 54% and intra-abdominal hypertension (IAH) in 21% patients. In patients with and without AKI, there was statistically similar IAP on day 1 ( = 0.542) and day 2 ( = 0.907) as well as incidence of IAH (19% vs. 23%) ( = 0.766). Area under receiver operating characteristic curve (AUC) for IAP to predict early AKI was 0.499 (95% confidence interval [CI]: 0.325-0.673) ( = 0.992). Urinary NGAL concentration was significantly greater in patients with early AKI compared to those without ( = 0.006); AUC for urinary NGAL to detect early AKI was 0.734 (95% CI: 0.583-0.884) ( = 0.006) and optimal cutoff was 53.7 ng/ml.
IAH and AKI are common in critically ill obstetric patients. While IAP does not correlate with early AKI, NGAL is useful to predict AKI.
本前瞻性队列研究评估了危重症产科患者的腹内压（IAP）及其在导致急性肾损伤（AKI）中的作用，以及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）预测AKI的效用。
共有50例符合条件的入住我们重症监护病房的产科患者入组，使用留置导尿管每日测量IAP。根据KDIGO标准诊断早期AKI，并使用酶联免疫吸附测定法（ELISA）评估尿液中的NGAL。
54%的患者出现AKI，21%的患者出现腹内高压（IAH）。在有和没有AKI的患者中，第1天（P = 0.542）和第2天（P = 0.907）的IAP以及IAH的发生率（19%对23%）（P = 0.766）在统计学上相似。IAP预测早期AKI的受试者工作特征曲线下面积（AUC）为0.499（95%置信区间[CI]：0.325 - 0.673）（P = 0.992）。与未发生早期AKI的患者相比，发生早期AKI的患者尿NGAL浓度显著更高（P = 0.006）；尿NGAL检测早期AKI的AUC为0.734（95% CI：0.583 - 0.884）（P = 0.006），最佳截断值为53.7 ng/ml。
IAH和AKI在危重症产科患者中很常见。虽然IAP与早期AKI无关，但NGAL对预测AKI有用。
