尿中性粒细胞明胶酶相关脂质运载蛋白与血清肌酐整合可区分危重症患儿急性肾损伤表型。

Integration of urinary neutrophil gelatinase-associated lipocalin with serum creatinine delineates acute kidney injury phenotypes in critically ill children.

机构信息

Cincinnati Children's Hospital Medical Center, Division of Critical Care Medicine, 3333 Burnet Avenue, MLC 2005, Cincinnati, OH 45229, United States of America.

University of Washington School of Medicine, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, United States of America.

出版信息

J Crit Care. 2019 Oct;53:1-7. doi: 10.1016/j.jcrc.2019.05.017. Epub 2019 May 28.

DOI:10.1016/j.jcrc.2019.05.017

PMID:31174170

Abstract

PURPOSE

Acute kidney injury (AKI) is prevalent in critically ill patients and associated with poor outcomes. Current AKI diagnostics- changes to serum creatinine (SCr) and urine output- are imprecise. Integration of injury biomarkers with SCr may improve diagnostic precision.

METHODS

We performed a secondary analysis of a study of critically ill children. Measurements of urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr samples from ICU admission facilitated the creation of four groups for comparison, based on elevation of SCr from baseline and reference NGAL cut-off value: uNGAL-/SCr-, uNGAL+/SCr-, uNGAL-/SCr + and uNGAL+/SCr+. The primary outcome assessed was AKI severity on Day 3.

RESULTS

178 children were studied. Compared to uNGAL-/SCr-, uNGAL+/SCr- patients had increased risk for all-stage Day 3 AKI (≥ KDIGO stage 1) (OR 3.83, [1.3-11.3], p = .025). Compared to uNGAL-/SCr+, uNGAL+/SCr + patients had increased risk for severe Day 3 AKI (≥ KDIGO stage 2) (OR 12, [1.4-102], p = .018). The only patients to suffer all-stage Day 3 AKI and mortality were uNGAL+ (3.2% uNGAL+/SCr-; 6.5% uNGAL+/SCr+).

CONCLUSIONS

Unique biomarker combinations on admission are predictive of distinct Day 3 AKI severity phenotypes. These classifications may enable a more personalized approach to the early management of AKI. Expanded study in larger populations is warranted.

摘要

目的

急性肾损伤（AKI）在危重症患者中较为常见，与不良预后相关。目前 AKI 的诊断标准——血清肌酐（SCr）和尿量的变化——并不精确。将损伤生物标志物与 SCr 相结合可能会提高诊断的准确性。

方法

我们对一项危重症儿童研究进行了二次分析。通过 ICU 入院时测量尿液中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）和 SCr 样本，根据 SCr 基线和参考 NGAL 截断值的升高，创建了 4 个组进行比较：uNGAL-/SCr-、uNGAL+/SCr-、uNGAL-/SCr+和 uNGAL+/SCr+。主要结局评估为第 3 天的 AKI 严重程度。

结果

研究共纳入 178 名儿童。与 uNGAL-/SCr-相比，uNGAL+/SCr-患者发生第 3 天所有阶段 AKI（≥ KDIGO 第 1 阶段）的风险增加（OR 3.83，[1.3-11.3]，p=0.025）。与 uNGAL-/SCr+相比，uNGAL+/SCr+患者发生第 3 天严重 AKI（≥ KDIGO 第 2 阶段）的风险增加（OR 12，[1.4-102]，p=0.018）。仅 uNGAL+患者发生所有阶段第 3 天 AKI 和死亡（3.2% uNGAL+/SCr-；6.5% uNGAL+/SCr+）。