尿液 α-1-微球蛋白水平与心脏手术后急性肾损伤、死亡和心血管事件。
Urine Alpha-1-Microglobulin Levels and Acute Kidney Injury, Mortality, and Cardiovascular Events following Cardiac Surgery.
机构信息
Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA,
Kidney Health Research Collaborative, San Francisco VA Health Care System & University of California, San Francisco, San Francisco, California, USA,
出版信息
Am J Nephrol. 2021;52(8):673-683. doi: 10.1159/000518240. Epub 2021 Sep 2.
INTRODUCTION
Urine alpha-1-microglobulin (Uα1m) elevations signal proximal tubule dysfunction. In ambulatory settings, higher Uα1m is associated with acute kidney injury (AKI), progressive chronic kidney disease (CKD), cardiovascular (CV) events, and mortality. We investigated the associations of pre- and postoperative Uα1m concentrations with adverse outcomes after cardiac surgery.
METHODS
In 1,464 adults undergoing cardiac surgery in the prospective multicenter Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort, we measured the pre-and postoperative Uα1m concentrations and calculated the changes from pre- to postoperative concentrations. Outcomes were postoperative AKI during index hospitalization and longitudinal risks for CKD incidence and progression, CV events, and all-cause mortality after discharge. We analyzed Uα1m continuously and categorically by tertiles using multivariable logistic regression and Cox proportional hazards regression adjusted for demographics, surgery characteristics, comorbidities, baseline estimated glomerular filtration rate, urine albumin, and urine creatinine.
RESULTS
There were 230 AKI events during cardiac surgery hospitalization; during median 6.7 years of follow-up, there were 212 cases of incident CKD, 54 cases of CKD progression, 269 CV events, and 459 deaths. Each 2-fold higher concentration of preoperative Uα1m was independently associated with AKI (adjusted odds ratio [aOR] = 1.36, 95% confidence interval 1.14-1.62), CKD progression (adjusted hazard ratio [aHR] = 1.46, 1.04-2.05), and all-cause mortality (aHR = 1.19, 1.06-1.33) but not with incident CKD (aHR = 1.21, 0.96-1.51) or CV events (aHR = 1.01, 0.86-1.19). Postoperative Uα1m was not associated with AKI (aOR per 2-fold higher = 1.07, 0.93-1.22), CKD incidence (aHR = 0.90, 0.79-1.03) or progression (aHR = 0.79, 0.56-1.11), CV events (aHR = 1.06, 0.94-1.19), and mortality (aHR = 1.01, 0.92-1.11).
CONCLUSION
Preoperative Uα1m concentrations may identify patients at high risk of AKI and other adverse events after cardiac surgery, but postoperative Uα1m concentrations do not appear to be informative.
简介
尿α-1-微球蛋白 (Uα1m) 升高表明近端肾小管功能障碍。在门诊环境中，Uα1m 升高与急性肾损伤 (AKI)、进展性慢性肾脏病 (CKD)、心血管 (CV) 事件和死亡率相关。我们研究了心脏手术后术前和术后 Uα1m 浓度与不良结局之间的关联。
方法
在前瞻性多中心转化研究中，我们对 1464 名接受心脏手术的成年人进行了研究，该研究调查了生物标志物终点在急性肾损伤中的作用（TRIBE-AKI）队列，我们测量了术前和术后 Uα1m 浓度，并计算了从术前到术后的浓度变化。术后住院期间的 AKI 是主要结局，以及 CKD 发生率和进展、CV 事件和出院后全因死亡率的纵向风险。我们使用多变量逻辑回归和 Cox 比例风险回归分析了 Uα1m 的连续性和三分位数，调整了人口统计学、手术特征、合并症、基线估计肾小球滤过率、尿白蛋白和尿肌酐。
结果
心脏手术住院期间有 230 例 AKI 事件；在中位 6.7 年的随访期间，有 212 例新发 CKD，54 例 CKD 进展，269 例 CV 事件和 459 例死亡。术前 Uα1m 浓度每增加 2 倍，与 AKI（调整优势比[aOR] = 1.36，95%置信区间 1.14-1.62）、CKD 进展（调整风险比[aHR] = 1.46，1.04-2.05）和全因死亡率（aHR = 1.19，1.06-1.33）独立相关，但与新发 CKD（aHR = 1.21，0.96-1.51）或 CV 事件（aHR = 1.01，0.86-1.19）无关。术后 Uα1m 与 AKI（每增加 2 倍的 aOR = 1.07，0.93-1.22）、CKD 发生率（aHR = 0.90，0.79-1.03）或进展（aHR = 0.79，0.56-1.11）、CV 事件（aHR = 1.06，0.94-1.19）和死亡率（aHR = 1.01，0.92-1.11）无关。
结论
术前 Uα1m 浓度可能可识别心脏手术后 AKI 和其他不良事件风险较高的患者，但术后 Uα1m 浓度似乎没有信息价值。
Zotero 插件