Medicine Major, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Blood Purif. 2023;52(3):285-295. doi: 10.1159/000526950. Epub 2022 Oct 20.
This prospective cohort study investigated the clinical role of circulating tumor necrosis factor receptor (cTNFR) levels as prognostic biomarkers in severe acute kidney injury (AKI) patients requiring continuous renal replacement therapy (CRRT).
We enrolled 136 patients from 7 hospitals participating in the VENUS (VolumE maNagement Under body composition monitoring in critically ill patientS on CRRT) trial from July 2017 to October 2019. The levels of cTNFR1 and cTNFR2 were measured using plasma samples collected on days 0 (D0), 2 (D2), and 7 (D7). Patients were divided into high- and low-cTNFR groups based on their receptor concentrations.
D0 concentrations of cTNFR1 and cTNFR2 were positively correlated with one another (R2 = 0.37, p < 0.001). The high-cTNFR1 group displayed a higher in-hospital mortality rate than the low-TNFR1 group (p = 0.002). Moreover, the mortality rate was significantly higher in the high-TNFR1 group than in the low-TNFR1 group after adjusting for age, sex, and acute physiology, and chronic health evaluation II scores (hazard ratio 1.82, 95% confidence interval 1.09-3.03, p = 0.025). D2 and D7 cTNFR1 levels were also associated with in-hospital mortality; contrastingly, cTNFR2 levels were not associated with this outcome. Additionally, patients were divided into three groups according to the change in cTNFR levels from D0 to D2 (ΔcTNFR). Those in the highest ΔcTNFR tertile had a higher mortality rate than the remaining patients (p = 0.033 for ΔcTNFR1; p = 0.025 for ΔcTNFR2). Patients who underwent AKI-to-chronic kidney disease transition had higher concentrations of cTNFR1 (p = 0.014).
DISCUSSION/CONCLUSION: Plasma cTNFR1 concentrations at CRRT initiation and changes in cTNFR1 and 2 levels immediately following CRRT initiation are significant biomarkers for predicting the outcomes of patients with severe AKI.
本前瞻性队列研究探讨了循环肿瘤坏死因子受体（cTNFR）水平作为需要连续肾脏替代治疗（CRRT）的严重急性肾损伤（AKI）患者预后生物标志物的临床作用。
我们从 2017 年 7 月至 2019 年 10 月从参与 VENUS（在接受 CRRT 的危重病患者中通过身体成分监测进行 VolumE 管理）试验的 7 家医院招募了 136 名患者。使用在第 0 天（D0）、第 2 天（D2）和第 7 天（D7）采集的血浆样本测量 cTNFR1 和 cTNFR2 的水平。根据受体浓度将患者分为高 cTNFR 和低 cTNFR 组。
cTNFR1 和 cTNFR2 的 D0 浓度彼此呈正相关（R2 = 0.37，p < 0.001）。高 cTNFR1 组的住院死亡率高于低 cTNFR1 组（p = 0.002）。此外，在调整年龄、性别和急性生理学和慢性健康评估 II 评分后，高 cTNFR1 组的死亡率明显高于低 cTNFR1 组（危险比 1.82，95%置信区间 1.09-3.03，p = 0.025）。D2 和 D7 cTNFR1 水平也与住院死亡率相关；相反，cTNFR2 水平与该结果无关。此外，根据从 D0 到 D2 的 cTNFR 水平变化将患者分为三组（ΔcTNFR）。最高 ΔcTNFR 三分位组的死亡率高于其余患者（p = 0.033 用于 ΔcTNFR1；p = 0.025 用于 ΔcTNFR2）。发生 AKI 向慢性肾脏病转变的患者 cTNFR1 浓度较高（p = 0.014）。
讨论/结论：CRRT 开始时的血浆 cTNFR1 浓度以及 CRRT 开始后即刻 cTNFR1 和 2 水平的变化是预测严重 AKI 患者结局的重要生物标志物。
