Ragán Dániel, Horváth-Szalai Zoltán, Szirmay Balázs, Mühl Diána
Department of Laboratory Medicine, Medical School, University of Pécs, Hungary.
Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Hungary.
EJIFCC. 2022 Apr 11;33(1):11-22. eCollection 2022 Apr.
Sepsis-related acute kidney injury (AKI) is one of the most common complications of sepsis at the intensive care unit (ICU) with more adverse mortality rates. The early diagnosis and reliable monitoring of sepsis-related AKI are essential in achieving a favorable outcome. Novel serum and urinary biomarkers could yield valuable information during this process. Regarding the widely used Kidney Disease Improving Global Outcomes (KDIGO) classifications, the diagnosis of AKI is still based on the increase of serum creatinine levels and the decrease of urine output; however, these parameters have limitations in reflecting the extent of kidney damage, therefore more sensitive and specific laboratory biomarkers are needed for the early diagnosis and prognosis of sepsis-related AKI. Regarding this, several serum parameters are discussed in this review including presepsin and the most important actin scavenger proteins (gelsolin, Gc-globulin) while other urinary markers are also examined including cell cycle arrest biomarkers, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), Cystatin C and actin. Novel biomarkers of sepsis-related AKI could facilitate the early diagnosis and monitoring of sepsis-related AKI.
脓毒症相关急性肾损伤(AKI)是重症监护病房(ICU)中脓毒症最常见的并发症之一,死亡率更高。对脓毒症相关AKI进行早期诊断和可靠监测对于取得良好预后至关重要。新型血清和尿液生物标志物在此过程中可提供有价值的信息。关于广泛使用的改善全球肾脏病预后组织(KDIGO)分类,AKI的诊断仍基于血清肌酐水平升高和尿量减少;然而,这些参数在反映肾脏损伤程度方面存在局限性,因此脓毒症相关AKI的早期诊断和预后需要更敏感、特异的实验室生物标志物。关于这一点,本综述讨论了几种血清参数,包括降钙素原和最重要的肌动蛋白清除蛋白(凝溶胶蛋白、Gc球蛋白),同时也研究了其他尿液标志物,包括细胞周期阻滞生物标志物、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)、胱抑素C和肌动蛋白。脓毒症相关AKI的新型生物标志物有助于脓毒症相关AKI的早期诊断和监测。