Emergency Department, Peking University People's Hospital, Beijing, China.
Emergency Department, Peking University People's Hospital, Beijing, China,
Cardiorenal Med. 2020;10(6):374-381. doi: 10.1159/000507387. Epub 2020 Oct 5.
Patients with acute myocardial infarction (AMI) are at high risk for acute kidney injury (AKI). Novel biomarkers that can predict AKI after AMI may facilitate immediate interventions. Recently, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), and klotho have been established as novel AKI biomarkers. However, their effects have not been studied in patients presenting with AMI. In this study, we will measure the serum levels of these three biomarkers to find reliable biomarkers for early diagnosis of AKI in AMI patients.
This prospective observational cohort study was conducted between May 2016 and November 2017. A total of 285 consecutive patients with AMI were enrolled. The study was approved by the institutional review board of Peking University People's Hospital (No. 2016PHB 042-01). AKI was defined according to the KDIGO criteria in 2012. At admission, the clinical data of patients was collected and serum levels of several AKI biomarkers, including cystatin C, NGAL, and klotho, were measured by ELISA. The relationship between biomarker levels of AKI were analyzed and their discrimination performances were compared.
AKI incidence was 17.5% (50/285) during hospitalization. Compared to patients without AKI, the AKI group had higher mortality (20.0% vs. 0.4%, p < 0.001) and tended to be older, had higher incidence of chronic kidney disease, severe cardiac function, more cardiac complications, larger doses of diuretics, and less use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker and statins. Moreover, AKI patients experienced an increase in serum cystatin C (3,709.2 ± 2,281.5 vs. 1,918.5 ± 1,140.6 ng/mL, p < 0.001), NGAL (118.0 ± 70.3 vs. 91.8 ± 52.3 ng/mL, p = 0.003), and klotho (742.2 ± 497.4 vs. 470.3 ± 257.2 pg/mL, p <0.001). Furthermore, the areas under the receiver operating curves demonstrated that serum cystatin C levels at admission had modest discriminative powers for predicting AKI after AMI compared with serum creatinine (0.899, 95% CI, 0.855-0.944 vs. 0.734, 95% CI, 0.649-0.819, p <0.001). There was no difference between the discrimination performances of serum creatinine, NGAL, and klotho.
Elevated cystatin C levels are associated with AKI in patients with AMI. This study provides reliable evidence that cystatin C levels may be superior to serum creatinine for predicting AKI after AMI at admission.
急性心肌梗死（AMI）患者发生急性肾损伤（AKI）的风险较高。能够预测 AMI 后 AKI 的新型生物标志物可能有助于立即进行干预。最近，胱抑素 C、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和 klotho 已被确立为新型 AKI 生物标志物。然而，它们在出现 AMI 的患者中的作用尚未得到研究。在这项研究中，我们将测量这三种生物标志物的血清水平，以找到可靠的生物标志物，用于早期诊断 AMI 患者的 AKI。
这是一项前瞻性观察队列研究，于 2016 年 5 月至 2017 年 11 月进行。共纳入 285 例连续 AMI 患者。该研究得到了北京大学人民医院机构审查委员会的批准（编号：2016PHB042-01）。AKI 按照 2012 年 KDIGO 标准定义。入院时，收集患者的临床数据，并通过 ELISA 测量几种 AKI 生物标志物（包括胱抑素 C、NGAL 和 klotho）的血清水平。分析了 AKI 生物标志物水平之间的关系，并比较了它们的鉴别性能。
住院期间 AKI 发生率为 17.5%（50/285）。与无 AKI 的患者相比，AKI 组的死亡率更高（20.0%比 0.4%，p<0.001），且年龄较大，慢性肾脏病、严重心功能、更多心脏并发症、利尿剂剂量更大、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和他汀类药物使用较少。此外，AKI 患者的血清胱抑素 C（3709.2±2281.5 比 1918.5±1140.6ng/ml，p<0.001）、NGAL（118.0±70.3 比 91.8±52.3ng/ml，p=0.003）和 klotho（742.2±497.4 比 470.3±257.2pg/ml，p<0.001）水平升高。此外，受试者工作特征曲线下面积表明，与血清肌酐相比，入院时血清胱抑素 C 水平对预测 AMI 后 AKI 具有中等的鉴别能力（0.899，95%CI，0.855-0.944 比 0.734，95%CI，0.649-0.819，p<0.001）。血清肌酐、NGAL 和 klotho 的鉴别性能无差异。
AMI 患者胱抑素 C 水平升高与 AKI 相关。本研究提供了可靠的证据，表明胱抑素 C 水平可能优于血清肌酐，用于预测 AMI 患者入院时的 AKI。
