血浆 NGAL：hepcidin-25 对体外循环心脏手术后主要不良肾脏事件的预测价值：一项初步研究。
Predictive Value of Plasma NGAL:Hepcidin-25 for Major Adverse Kidney Events After Cardiac Surgery with Cardiopulmonary Bypass: A Pilot Study.
机构信息
Medical Faculty, University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Diaverum Renal Services, MVZ Potsdam, Potsdam, Germany.
出版信息
Ann Lab Med. 2021 Jul 1;41(4):357-365. doi: 10.3343/alm.2021.41.4.357.
BACKGROUND
Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin-25 are involved in catalytic iron-related kidney injury after cardiac surgery with cardiopulmonary bypass. We explored the predictive value of plasma NGAL, plasma hepcidin-25, and the plasma NGAL:hepcidin-25 ratio for major adverse kidney events (MAKE) after cardiac surgery.
METHODS
We compared the predictive value of plasma NGAL, hepcidin-25, and plasma NGAL:hepcidin-25 with that of serum creatinine (Cr) and urinary output and protein for primary-endpoint MAKE (acute kidney injury [AKI] stages 2 and 3, persistent AKI >48 hours, acute dialysis, and in-hospital mortality) and secondary-endpoint AKI in 100 cardiac surgery patients at intensive care unit (ICU) admission. We performed ROC curve, logistic regression, and reclassification analyses.
RESULTS
At ICU admission, plasma NGAL, plasma NGAL:hepcidin-25, plasma interleukin-6, and Cr predicted MAKE (area under the ROC curve [AUC]: 0.77, 0.79, 0.74, and 0.74, respectively) and AKI (0.73, 0.89, 0.70, and 0.69). For AKI prediction, plasma NGAL:hepcidin-25 had a higher discriminatory power than Cr (AUC difference 0.26 [95% CI 0.00-0.53]). Urinary output and protein, plasma lactate, C-reactive protein, creatine kinase myocardial band, and brain natriuretic peptide did not predict MAKE or AKI (AUC <0.70). Only plasma NGAL:hepcidin-25 correctly reclassified patients according to their MAKE and AKI status (category-free net reclassification improvement: 0.82 [95% CI 0.12-1.52], 1.03 [0.29-1.77]). After adjustment to the Cleveland risk score, plasma NGAL:hepcidin-25 ≥0.9 independently predicted MAKE (adjusted odds ratio 16.34 [95% CI 1.77-150.49], =0.014).
CONCLUSIONS
Plasma NGAL:hepcidin-25 is a promising marker for predicting postoperative MAKE.
背景
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和铁调素-25 参与体外循环心脏手术后与催化铁相关的肾损伤。我们探讨了血浆 NGAL、血浆铁调素-25 和血浆 NGAL：铁调素-25 比值对心脏手术后主要不良肾脏事件（MAKE）的预测价值。
方法
我们比较了血浆 NGAL、铁调素-25 和血浆 NGAL：铁调素-25 与血清肌酐（Cr）和尿量及尿蛋白对 100 例 ICU 入院时心脏手术患者的主要终点（AKI 第 2 期和第 3 期、持续 AKI>48 小时、急性透析和院内死亡率）和次要终点 AKI 的预测价值。我们进行了 ROC 曲线、逻辑回归和再分类分析。
结果
在 ICU 入院时，血浆 NGAL、血浆 NGAL：铁调素-25、血浆白细胞介素-6 和 Cr 预测了 MAKE（ROC 曲线下面积 [AUC]：0.77、0.79、0.74 和 0.74）和 AKI（0.73、0.89、0.70 和 0.69）。对于 AKI 预测，血浆 NGAL：铁调素-25 的判别能力高于 Cr（AUC 差值 0.26 [95%CI 0.00-0.53]）。尿量和尿蛋白、血浆乳酸、C 反应蛋白、肌酸激酶心肌带和脑钠肽均不能预测 MAKE 或 AKI（AUC<0.70）。只有血浆 NGAL：铁调素-25 能够根据患者的 MAKE 和 AKI 状态正确地重新分类（无分类净重新分类改善：0.82 [95%CI 0.12-1.52]，1.03 [0.29-1.77]）。在调整克利夫兰风险评分后，血浆 NGAL：铁调素-25≥0.9 独立预测 MAKE（调整后的优势比 16.34 [95%CI 1.77-150.49]，=0.014）。
结论
血浆 NGAL：铁调素-25 是预测术后 MAKE 的有前途的标志物。
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