尿中性粒细胞明胶酶相关脂质运载蛋白在进入重症监护病房的第二天即可作为预测指标，但在进入重症监护病房的当天则不行。

Urinary neutrophil gelatinase-associated lipocalin was a predictor from the day after intensive care unit entry, but not on the day of intensive care unit entry.

机构信息

Department of Anesthesiology, Osaka Medical College, Intensive Care Unit, Osaka Medical College Hospital, Takatsuki, Osaka 569-8686, Japan.

出版信息

Clin Chim Acta. 2021 Jun;517:117-121. doi: 10.1016/j.cca.2021.02.017. Epub 2021 Mar 2.

DOI:10.1016/j.cca.2021.02.017

PMID:33667482

Abstract

BACKGROUND AND AIMS

Sepsis is the main cause of death from infection. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) values better predict mortality in septic patients when combined with inflammation-based prognostic scores.

MATERIAL AND METHODS

Forty-four adult patients diagnosed according to the Sepsis-3 definition and who were admitted to the ICU were prospectively examined from June 2018 to November 2018. Urine samples were collected from each patient with a urethral balloon bag to measure NGAL after ICU entry at the following time points: immediately after and 2, 3, and 4 days after ICU entry. The Glasgow Prognostic Score, the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio, the Prognostic Nutritional Index, the Prognostic Index (PI), the Sequential Organ Failure Assessment (SOFA), and quick SOFA were examined immediately after ICU entry. Predictors of mortality were assessed by receiver operating characteristics curve (ROC) analysis, log-rank test, and multivariate logistic regression analysis.

RESULTS

NGAL on day 4 (AUC: 0.94) and ΔNGAL from day 4 to day 1 (AUC: 0.9) for 28-day mortality; NGAL on day 4 (AUC: 0.94) and inflammation-NGAL score (iNS) NGAL-PI (AUC: 0.69) for 60-day mortality; ΔNGAL from day 3 to day 1 (AUC: 0.82) for 90-day mortality; and iNS NGAL-NLR (AUC: 0.71) and iNS NGAL-PI (AUC: 0.68) for in-hospital mortality were found to be predictors of mortality by ROC curve analysis. NLR (p = 0.02) for 28-day mortality; NGAL on day 2 (p = 0.031), ΔNGAL from day 2 to day 1 (p = 0.013), and NLR (p < 0.0001) for 60-day mortality; NGAL on day 2 (p = 0.017), ΔNGAL from day 2 to day 1 (p = 0.014), and NLR (p = 0.033) for 90-day mortality; and NGAL on day 2 (p = 0.007) for in-hospital mortality were found to be predictors of mortality by log-rank test. iNS NGAL-NLR (OR, 0.024; p = 0.019) for 60-day mortality and NGAL from day 3 to day 1 (OR, 1.005; p = 0.013) for 90-day mortality were found to be predictors of mortality by multivariate logistic regression analysis.

CONCLUSIONS

NGAL and ΔNGAL were predictors of mortality in sepsis patients on day 2 after ICU entry and thereafter, but not on day 1.

摘要

背景与目的

脓毒症是感染导致死亡的主要原因。本研究旨在确定中性粒细胞明胶酶相关脂质运载蛋白（NGAL）值与基于炎症的预后评分相结合是否能更好地预测脓毒症患者的死亡率。

材料与方法

2018 年 6 月至 11 月，前瞻性地检查了根据 Sepsis-3 定义诊断的 44 名成年 ICU 入院患者。在 ICU 入院后以下时间点，使用尿道球囊袋采集每位患者的尿液样本，以测量 NGAL：入院后立即、第 2、3、4 天。入院后立即检查格拉斯哥预后评分、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、预后营养指数、预后指数（PI）、序贯器官衰竭评估（SOFA）和快速 SOFA。通过接收者操作特征曲线（ROC）分析、对数秩检验和多变量逻辑回归分析评估死亡率的预测因素。

结果

第 4 天的 NGAL（AUC：0.94）和第 4 天至第 1 天的 ΔNGAL（AUC：0.9）预测 28 天死亡率；第 4 天的 NGAL（AUC：0.94）和炎症-NGAL 评分（iNS）NGAL-PI（AUC：0.69）预测 60 天死亡率；第 3 天至第 1 天的 ΔNGAL（AUC：0.82）预测 90 天死亡率；iNS NGAL-NLR（AUC：0.71）和 iNS NGAL-PI（AUC：0.68）预测住院死亡率。通过 ROC 曲线分析发现，NLR（p=0.02）预测 28 天死亡率；第 2 天的 NGAL（p=0.031）、第 2 天至第 1 天的 ΔNGAL（p=0.013）和 NLR（p<0.0001）预测 60 天死亡率；第 2 天的 NGAL（p=0.017）、第 2 天至第 1 天的 ΔNGAL（p=0.014）和 NLR（p=0.033）预测 90 天死亡率；第 2 天的 NGAL（p=0.007）预测住院死亡率。通过对数秩检验发现，iNS NGAL-NLR（OR，0.024；p=0.019）预测 60 天死亡率，第 3 天至第 1 天的 NGAL（OR，1.005；p=0.013）预测 90 天死亡率。通过多变量逻辑回归分析发现，第 2 天的 NGAL 和 ΔNGAL 是 ICU 入院后第 2 天及之后脓毒症患者死亡率的预测因素，但第 1 天不是。