Sakyi Samuel Asamoah, Ephraim Richard K Dadzie, Adoba Prince, Amoani Benjamin, Buckman Tonnies, Mantey Richard, Eghan Benjamin A
Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Ghana.
Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
Heliyon. 2021 Sep 6;7(9):e07960. doi: 10.1016/j.heliyon.2021.e07960. eCollection 2021 Sep.
Acute kidney injury (AKI) is routinely diagnosed by creatinine-based guidelines, which is sub-optimal marker after injury due to renal and non-renal factors. This has necessitated the need for more specific and sensitive biomarkers for early detection of AKI in at risk patients. This prospective cross-sectional study used the biomarkers of cell cycle arrest and Neutrophil Gelatinase Associated Lipocalin (NGAL) to assess AKI among hospitalized patients.
We conveniently enrolled 151 in-patients at the Trauma and Specialist Hospital, Winneba in Ghana. Socio-demographic and clinical information were collected using structured questionnaires. Blood samples were collected for the estimation of serum creatinine, and AKI diagnosed and staged using the KDIGO guideline. Fresh urine samples were collected and urinary NGAL, TIMP-2 (tissue inhibitor metalloproteinase 2) and IGFBP-7 (insulin-like growth factor binding protein 7) were estimated using ELISA kits.
The cell cycle arrest biomarkers and NGAL were significantly (P < 0.001) higher among participants with AKI than those without AKI. [TIMP-2]∗[IGFBP-7] showed the best diagnostic performance (AUC = 0.94, CI = 0.90-0.98) followed by [IGFBP-7]∗NGAL] (AUC = 0.93, CI = 0.87-0.99), with NGAL having the least (AUC = 0.62, CI = 0.46-0.78). The cut-off for [TIMP-2]∗[IGFBP-7] showed the best predictive ability (95.8% sensitivity, 77.2% specificity, 44.2% PPV and 99% NPV). The cut-off for NGAL, on the other hand, showed the least predictive ability (62.5% sensitivity, 42.5% specificity, 17.0% PPV and 85.7% NPV).
Tissue inhibitor metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) best predicts the development of AKI, and can be used in high risk patients for early diagnosis of AKI.
急性肾损伤（AKI）通常根据基于肌酐的指南进行诊断，然而由于肾脏和非肾脏因素，肌酐在损伤后并非最佳标志物。因此，需要更特异、敏感的生物标志物来早期检测高危患者的AKI。这项前瞻性横断面研究使用细胞周期阻滞生物标志物和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）来评估住院患者中的AKI。
我们在加纳温尼巴的创伤与专科医院方便地纳入了151名住院患者。使用结构化问卷收集社会人口统计学和临床信息。采集血样以测定血清肌酐，并根据KDIGO指南诊断和分期AKI。收集新鲜尿液样本，使用酶联免疫吸附测定试剂盒测定尿NGAL、组织金属蛋白酶抑制剂2（TIMP-2）和胰岛素样生长因子结合蛋白7（IGFBP-7）。
与未患AKI的参与者相比，患AKI的参与者的细胞周期阻滞生物标志物和NGAL显著更高（P < 0.001）。[TIMP-2]×[IGFBP-7]表现出最佳诊断性能（曲线下面积[AUC]=0.94，可信区间[CI]=0.90 - 0.98），其次是[IGFBP-7]×[NGAL]（AUC = 0.93，CI = 0.87 - 0.99），NGAL的诊断性能最差（AUC = 0.62，CI = 0.46 - 0.78）。[TIMP-2]×[IGFBP-7]的临界值表现出最佳预测能力（灵敏度95.8%，特异度77.2%，阳性预测值44.2%，阴性预测值99%）。另一方面，NGAL的临界值预测能力最差（灵敏度62.5%，特异度42.5%，阳性预测值17.0%，阴性预测值85.7%）。
组织金属蛋白酶抑制剂2（TIMP-2）和胰岛素样生长因子结合蛋白7（IGFBP7）对AKI的发生具有最佳预测能力，可用于高危患者AKI的早期诊断。
