Beitland Sigrid, Nakstad Espen Rostrup, Berg Jens Petter, Trøseid Anne-Marie Siebke, Brusletto Berit Sletbakk, Brunborg Cathrine, Lundqvist Christofer, Sunde Kjetil
Institute of Clinical Medicine, University of Oslo, P.O.Box 1072 Blindern, 0316 Oslo, Norway.
Department of Anaesthesiology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway.
Crit Care Res Pract. 2019 May 7;2019:4384796. doi: 10.1155/2019/4384796. eCollection 2019.
Acute kidney injury (AKI) is a common complication after out-of-hospital cardiac arrest (OHCA), leading to increased mortality and challenging prognostication. Our aim was to examine if urine biomarkers could early predict postarrest AKI and patient outcome.
A prospective observational study of resuscitated, comatose OHCA patients admitted to Oslo University Hospital in Norway. Urine samples were collected at admission and day three postarrest and analysed for -2-microglobulin (2M), osteopontin, and trefoil factor 3 (TFF3). Outcome variables were AKI within three days according to the Kidney Disease Improving Global Outcome criteria, in addition to six-month mortality and poor neurological outcome (PNO) (cerebral performance category 3-5).
Among 195 included patients (85% males, mean age 60 years), 88 (45%) developed AKI, 88 (45%) died, and 96 (49%) had PNO. In univariate analyses, increased urine 2M, osteopontin, and TFF3 levels sampled at admission and day three were independent risk factors for AKI, mortality, and PNO. Exceptions were that 2M measured at day three did not predict any of the outcomes, and TFF3 at admission did not predict AKI. In multivariate analyses, combining clinical parameters and biomarker levels, the area under the receiver operating characteristics curves (95% CI) were 0.729 (0.658-0.800), 0.797 (0.733-0.861), and 0.812 (CI 0.750-0.874) for AKI, mortality, and PNO, respectively.
Urine levels of 2M, osteopontin, and TFF3 at admission and day three were associated with increased risk for AKI, mortality, and PNO in comatose OHCA patients. This trail is registered with NCT01239420.
急性肾损伤（AKI）是院外心脏骤停（OHCA）后的常见并发症，会导致死亡率增加且预后判断具有挑战性。我们的目的是研究尿生物标志物是否能早期预测心脏骤停后AKI及患者预后。
对挪威奥斯陆大学医院收治的复苏后昏迷的OHCA患者进行一项前瞻性观察研究。入院时及心脏骤停后第3天采集尿样，分析其中的β2-微球蛋白（β2M）、骨桥蛋白和三叶因子3（TFF3）。根据改善全球肾脏病预后组织（KDIGO）标准，结局变量为3天内发生的AKI，此外还有6个月死亡率和不良神经结局（PNO）（脑功能分类3 - 5级）。
在195例纳入患者中（85%为男性，平均年龄60岁），88例（45%）发生AKI，88例（45%）死亡，96例（49%）有PNO。在单因素分析中，入院时及第3天采集到的尿β2M、骨桥蛋白和TFF3水平升高是AKI、死亡率和PNO的独立危险因素。例外情况是第3天测得的β2M不能预测任何结局，入院时的TFF3不能预测AKI。在多因素分析中，结合临床参数和生物标志物水平，AKI、死亡率和PNO的受试者工作特征曲线下面积（95%CI）分别为0.729（0.658 - 0.800）、0.797（0.733 - 0.861）和0.812（CI 0.750 - 0.874）。
入院时及第3天的尿β2M、骨桥蛋白和TFF3水平与昏迷OHCA患者发生AKI、死亡及PNO的风险增加相关。本试验已在ClinicalTrials.gov注册，注册号为NCT01239420。
