Lupu Lior, Rozenfeld Keren-Lee, Zahler David, Morgan Samuel, Merdler Ilan, Shtark Moshe, Goldiner Ilana, Banai Shmuel, Shacham Yacov
Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 64239, Israel.
J Clin Med. 2021 May 14;10(10):2120. doi: 10.3390/jcm10102120.
A subgroup of patients with acute kidney injury (AKI) do not fulfil the functional criteria for AKI diagnosis but show elevated levels of new biomarkers reflecting tubular injury, suggesting that these patients suffer "subclinical AKI". We investigated the incidence and possible implications of "subclinical AKI", compared to no and clinical AKI among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI).
We included 223 patients with STEMI treated with PCI. Neutrophil gelatinase-associated lipocalin (NGAL) was used as a marker of renal tubular damage in the absence of functional AKI, with NGAL levels ≥100 ng/mL suggesting subclinical AKI. Patients were assessed for the occurrence of in-hospital adverse outcomes.
Of the study patients, 45 (25%) had subclinical AKI. These patients were more likely to have left ventricular ejection fraction ≤45% (33% vs. 23%. = 0.01), in-hospital adverse outcomes (73% vs. 48%; = 0.005), and a combination of the two. The multivariate regression model demonstrated that subclinical AKI was independently associated with in-hospital adverse outcomes (OR 3.71, 95% CI 1.30-10.62, = 0.02).
Subclinical AKI is common among STEMI patients and is independently associated with adverse outcomes, even in the absence of functional AKI.
急性肾损伤（AKI）患者中的一个亚组不符合AKI诊断的功能标准，但显示反映肾小管损伤的新生物标志物水平升高，这表明这些患者患有“亚临床AKI”。我们调查了“亚临床AKI”的发生率及其可能的影响，并将其与接受直接冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死患者（STEMI）中的无AKI和临床AKI情况进行比较。
我们纳入了223例接受PCI治疗的STEMI患者。在不存在功能性AKI的情况下，中性粒细胞明胶酶相关脂质运载蛋白（NGAL）被用作肾小管损伤的标志物，NGAL水平≥100 ng/mL提示亚临床AKI。评估患者住院期间不良结局的发生情况。
在研究患者中，45例（25%）有亚临床AKI。这些患者更有可能出现左心室射血分数≤45%（33%对23%，P = 0.01）、住院期间不良结局（73%对48%；P = 0.005）以及两者并存。多变量回归模型显示，亚临床AKI与住院期间不良结局独立相关（比值比3.71，95%置信区间1.30 - 10.62，P = 0.02）。
亚临床AKI在STEMI患者中很常见，并且即使在不存在功能性AKI的情况下也与不良结局独立相关。
