中国危重症成人急性肾损伤检测中血清 N 末端脑利钠肽前体和胱抑素 C 的前瞻性观察研究。

Serum N-terminal pro-B-type natriuretic peptide and cystatin C for acute kidney injury detection in critically ill adults in China: a prospective, observational study.

机构信息

The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.

出版信息

BMJ Open. 2023 Jan 30;13(1):e063896. doi: 10.1136/bmjopen-2022-063896.

DOI:10.1136/bmjopen-2022-063896

PMID:36717146

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9887693/

Abstract

OBJECTIVE

Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cystatin C (sCysC) are available clinically and beneficial in diagnosing acute kidney injury (AKI). Our purpose is to identify the performance of their combined diagnosis for AKI in critically ill patients.

DESIGN

A prospectively recruited, observational study was performed.

SETTING

Adults admitted to the intensive care unit of a tertiary hospital in China.

PARTICIPANTS

A total of 1222 critically ill patients were enrolled in the study.

MAIN OUTCOME MEASURES

To identify the performance of the combined diagnosis of serum NT-proBNP and sCysC for AKI in critically ill patients. The area under the receiver operating characteristic curve (AUC-ROC), category-free net reclassification index (NRI) and incremental discrimination improvement (IDI) were utilised for comparing the discriminative powers of a combined and single biomarker adjusted model of clinical variables enriched with NT-proBNP and sCysC for AKI.

RESULTS

AKI was detected in 256 out of 1222 included patients (20.9%). AUC-ROC for NT-proBNP and sCysC to detect AKI had a significantly higher accuracy than any individual biomarker (p<0.05). After multivariate adjustment, a level of serum NT-proBNP ≥204 pg/mL was associated with 3.5-fold higher odds for AKI compared with those below the cut-off value. Similar results were obtained for sCysC levels (p<0.001). To detect AKI, adding NT-proBNP and sCysC to a clinical model further increased the AUC-ROC to 0.859 beyond that of the clinical model with or without sCysC (p<0.05). Moreover, the addition of these two to the clinical model significantly improved risk reclassification of AKI beyond that of the clinical model alone or with single biomarker (p<0.05), as measured by NRI and IDI.

CONCLUSIONS

In critically ill individuals, serum NT-proBNP, sCysC and clinical risk factors combination improve the discriminative power for diagnosing AKI.

摘要

目的

血清 N 末端脑利钠肽前体（NT-proBNP）和胱抑素 C（sCysC）在临床上均可用，且有利于急性肾损伤（AKI）的诊断。我们的目的是确定它们联合诊断危重症患者 AKI 的性能。

设计

前瞻性招募，观察性研究。

地点

中国一家三级医院的重症监护病房。

参与者

共纳入 1222 例危重症患者。

主要观察指标

确定血清 NT-proBNP 和 sCysC 联合诊断危重症患者 AKI 的性能。采用受试者工作特征曲线下面积（AUC-ROC）、无分类净重新分类指数（NRI）和增量判别改善（IDI）比较联合和单生物标志物调整模型的判别能力，该模型使用 NT-proBNP 和 sCysC 丰富了临床变量。

结果

在纳入的 1222 例患者中，有 256 例（20.9%）检测到 AKI。与任何单个生物标志物相比，NT-proBNP 和 sCysC 检测 AKI 的 AUC-ROC 具有更高的准确性（p<0.05）。在多变量调整后，与截断值以下的患者相比，血清 NT-proBNP 水平≥204 pg/mL 与 AKI 的发生风险增加 3.5 倍相关。sCysC 水平也得到了类似的结果（p<0.001）。为了检测 AKI，将 NT-proBNP 和 sCysC 添加到临床模型中可使 AUC-ROC 进一步提高至 0.859，超过了仅包含 sCysC 的临床模型（p<0.05）。此外，与仅使用临床模型或单个生物标志物相比，将这两个生物标志物添加到临床模型中可显著改善 AKI 的风险再分类（p<0.05），这是通过 NRI 和 IDI 来衡量的。