Lima Camila, Gorab Daniella Lacerda, Fernandes Carol Ribeiro, Macedo Etienne
Internal Medicine Department, Nephrology Division, University of Sao Paulo, Sao Paulo, Brazil.
Nursing Course, Faculty Israelita of Health Sciences Albert Einstein, Sao Paulo, Brazil.
Pract Lab Med. 2022 May 6;31:e00278. doi: 10.1016/j.plabm.2022.e00278. eCollection 2022 Aug.
In recent decades, clinical research on early biomarkers of renal injury has been frequent and intensive, with proenkephalin (PENK) being indicated as a promising filtration biomarker (BM). From a cohort of 57 patients, blood samples were collected preoperatively and 48 h after liver transplantation (LT). The following BMs were analyzed: PENK, cystatin-C (CYS-C), and serum creatinine (Scr). Diagnosis of AKI was based on the KDIGO criteria. Of the 57 patients undergoing LT, 50 (88%) developed acute kidney injury (AKI) and were categorized as follows: no-AKI/mild-AKI - 21 (36.8%) and severe-AKI 36 (63.2%). During the preoperative period, only PENK was significantly higher in patients with severe AKI, with an AUC of 0.69 (CI 0.54-0.83), a cutoff of 55.30 pmol/l, a sensitivity of 0.86, a specificity of 0.52, and an accuracy of 0.75. In addition, subclinical AKI was determined preoperatively in 32 patients. Forty-eight hours after LT, PENK maintained its performance in determining severe AKI, with an AUC of 0.83 (CI 0.72-0.94), a cutoff of 119.05 pmol/l, a sensitivity of 0.81, a specificity of 0.90, and an accuracy of 0.84. PENK detected AKI 48 h earlier than serum creatinine. In a multivariate linear regression analysis, PENK was an independent predictor of severe AKI. This small study suggests that the filtration biomarker PENK shows promise for detecting AKI in patients undergoing LT, revealing greater accuracy and an earlier rise in patients with severe AKI. The combination of kidney functional and filtration BMs may aid in the management and prevention of AKI progression.
近几十年来，关于肾损伤早期生物标志物的临床研究频繁且深入，前脑啡肽原（PENK）被认为是一种有前景的滤过生物标志物（BM）。从57例患者的队列中，在肝移植（LT）术前和术后48小时采集血样。分析了以下生物标志物：PENK、胱抑素C（CYS - C）和血清肌酐（Scr）。急性肾损伤（AKI）的诊断基于KDIGO标准。在接受LT的57例患者中，50例（88%）发生了急性肾损伤（AKI），并分类如下：无AKI/轻度AKI - 21例（36.8%），重度AKI 36例（63.2%）。在术前阶段，只有重度AKI患者的PENK显著升高，曲线下面积（AUC）为0.69（95%置信区间0.54 - 0.83），截断值为55.30 pmol/l，灵敏度为0.86，特异性为0.52，准确度为0.75。此外，术前在32例患者中确定了亚临床AKI。LT术后48小时，PENK在确定重度AKI方面保持其性能，AUC为0.83（95%置信区间0.72 - 0.94），截断值为119.05 pmol/l，灵敏度为0.81，特异性为0.90，准确度为0.84。PENK比血清肌酐早48小时检测到AKI。在多变量线性回归分析中，PENK是重度AKI的独立预测因子。这项小型研究表明，滤过生物标志物PENK在检测接受LT患者的AKI方面显示出前景，在重度AKI患者中具有更高准确性和更早升高。肾功能和滤过生物标志物的联合应用可能有助于AKI进展的管理和预防。
