Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.
Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.
Respirology. 2019 Apr;24(4):345-351. doi: 10.1111/resp.13464. Epub 2019 Jan 17.
Angiopoietin-2 (AGPT2) has been proposed as a key mediator of organ dysfunction, mainly in acute respiratory distress syndrome (ARDS). It has also been associated with acute kidney injury (AKI). We aimed to investigate the role of AGPT2 in patients with and without ARDS.
In a cohort study with critically ill patients, AGPT1 and AGPT2 were assayed in plasma collected within the first 24 h after admission to intensive care unit (ICU). Severe AKI and the need for dialysis were outcome measures from comparative analysis with clinical characteristics useful for AKI risk stratification.
Among 283 patients (50.2% males), 109 (38.5%) had ARDS. AGPT2 levels at admission were higher in patients with ARDS. Although overall AGPT2 and AGPT2/AGPT1 levels were associated with severe AKI, this association was not significant in patients without ARDS; however, it remained strongly significant in ARDS patients. In patients without ARDS, AGPT2 showed only a weak discriminatory capacity to predict severe AKI (area under the curve (AUC): 0.64 vs 0.81 in the ARDS group). The continuous net reclassification improvement (NRI) in the ARDS group resulting from AGPT2 inclusion was 64.1% (P < 0.001) and the integrated discrimination improvement (IDI) index was 0.057 (P = 0.003). There was no significant difference in NRI in the no-ARDS group.
AGPT2 and AGPT2/AGPT1 ratio are associated with severe AKI and there was only a need of renal replacement therapy (RRT) in patients with or at risk of ARDS, not in other critically ill patients. Adding AGPT2 to a clinical model resulted in a significant improvement in the capacity to predict severe AKI specifically in ARDS patients.
血管生成素-2（AGPT2）被认为是器官功能障碍的关键介质，主要在急性呼吸窘迫综合征（ARDS）中。它也与急性肾损伤（AKI）有关。我们旨在研究 AGPT2 在伴有和不伴有 ARDS 的患者中的作用。
在一项对危重症患者的队列研究中，在入住重症监护病房（ICU）的头 24 小时内采集血浆，检测 AGPT1 和 AGPT2。严重 AKI 和需要透析是与有助于 AKI 风险分层的临床特征进行比较分析的结果指标。
在 283 名患者（50.2%为男性）中，109 名（38.5%）患有 ARDS。ARDS 患者入院时 AGPT2 水平较高。虽然总体上 AGPT2 和 AGPT2/AGPT1 水平与严重 AKI 相关，但在无 ARDS 的患者中这种相关性不显著；然而，在 ARDS 患者中仍然具有很强的相关性。在无 ARDS 的患者中，AGPT2 仅对预测严重 AKI 具有较弱的区分能力（曲线下面积（AUC）：ARDS 组为 0.81）。由于 AGPT2 的纳入，ARDS 组的连续净重新分类改善（NRI）为 64.1%（P < 0.001），综合判别改善（IDI）指数为 0.057（P = 0.003）。无 ARDS 组的 NRI 无显著差异。
AGPT2 和 AGPT2/AGPT1 比值与严重 AKI 相关，只有伴有或有 ARDS 风险的患者需要肾脏替代治疗（RRT），而其他危重症患者则不需要。将 AGPT2 添加到临床模型中可显著提高对 ARDS 患者严重 AKI 的预测能力。
