Clinical Investigation Facility, David Grant US Air Force Medical Center, Travis Air Force Base, CA; Department of Surgery, University of California Davis Medical Center, Sacramento, CA.
US Army Institute for Surgical Research, Joint Base San Antonio, Ft Sam Houston, TX.
J Am Coll Surg. 2019 Nov;229(5):508-515.e1. doi: 10.1016/j.jamcollsurg.2019.07.003. Epub 2019 Jul 19.
Risk prediction is important during combat operations because resources are limited and triage decisions must be rapid and accurate. We evaluated 2 point-of-care urinary biomarker tests for risk prediction in combat casualties.
This was an observational cohort study of critically injured military personnel admitted to Craig Joint Theater Hospital in Afghanistan from October 2012 to December 2013. We collected urine within 3 hours of admission and measured urinary biomarkers with NephroCheck and a neutrophil gelatinase-associated lipocalin dipstick (NGALds) to evaluate their ability to predict a combined end point of need for renal replacement therapy or death. Odds ratios (ORs) were calculated and receiver operator characteristic curves were generated for both tests.
A total of 89 patients were included for analysis. The median Injury Severity Score was 18 and the combined end point occurred in 12 (13.5%) patients. NephroCheck was not associated with the combined end point (OR 1.56; 95% CI 0.81 to 3.03; p = 0.19) and the area under the curve of the receiver operator characteristic curve was 0.65. The NGALds was highly associated with the combined end point (OR 4.93; 95% CI 2.18 to 11.14; p < 0.001) and the area under the curve of the receiver operator characteristic curve was 0.84. The NGALds remained significantly associated with the combined end point in a logistic regression model that included Injury Severity Score as a covariate (OR 4.10; 95% CI 1.74 to 9.67; p = 0.001).
Measurement of urinary biomarkers with an NGALds, but not NephroCheck, predicts poor outcomes in combat casualties. An NGALds is a simple urine dipstick that could be deployed to combat zones to prioritize aeromedical evacuation, help with triage decisions, and predict resource use.
在作战行动中，风险预测很重要，因为资源有限，分诊决策必须迅速准确。我们评估了两种即时尿液生物标志物检测在作战伤员中的风险预测作用。
这是一项观察性队列研究，纳入了 2012 年 10 月至 2013 年 12 月期间在阿富汗克雷格联合战区医院收治的危重伤员。我们在入院后 3 小时内采集尿液，并使用 NephroCheck 和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）检测试纸条测量尿液生物标志物，以评估它们预测需要肾脏替代治疗或死亡的复合终点的能力。计算了比值比（OR），并为两种检测方法生成了接收者操作特征曲线。
共纳入 89 例患者进行分析。损伤严重程度评分中位数为 18 分，12 例（13.5%）患者发生复合终点事件。NephroCheck 与复合终点无关（OR 1.56；95%CI 0.81 至 3.03；p=0.19），接收者操作特征曲线下面积为 0.65。NGALds 与复合终点高度相关（OR 4.93；95%CI 2.18 至 11.14；p<0.001），接收者操作特征曲线下面积为 0.84。在包括损伤严重程度评分作为协变量的逻辑回归模型中，NGALds 与复合终点仍显著相关（OR 4.10；95%CI 1.74 至 9.67；p=0.001）。
使用 NGALds 而非 NephroCheck 测量尿液生物标志物可预测作战伤员的不良结局。NGALds 是一种简单的尿液检测试纸，可以部署到作战区，以优先安排航空医疗后送，帮助分诊决策，并预测资源使用情况。
