术后 4 小时单次检测 NephroCheck™ 并不能预测非体外循环冠状动脉旁路移植术的急性肾损伤。
Single value of NephroCheck™ performed at 4 hours after surgery does not predict acute kidney injury in off-pump coronary artery bypass surgery.
机构信息
Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India.
Department of Cardiac Anaesthesia, Narayana Superspeciality Hospital, Gurugram, Haryana, India.
出版信息
Ann Card Anaesth. 2023 Jan-Mar;26(1):57-62. doi: 10.4103/aca.aca_56_21.
BACKGROUND
Quantification of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IFGBP-7), which is commercially known as NephroCheck™(NC) test have been suggested as promising tools for the early detection of acute kidney injury (AKI) after cardiac surgery involving cardio-pulmonary bypass (CPB).
OBJECTIVES
The aim of the present study was to test the hypothesis that single value of postoperative NC test performed at 4 hours after surgery can predict AKI in off-pump coronary artery bypass grafting (OPCABG) surgery.
SETTING AND DESIGN
This prospective single-center study was conducted at the tertiary cardiac center in India from December 2017 to November 2018.
METHODS
Ninety adult patients of both sex undergoing elective OPCABG were included. Anesthesia was standardized to all patients. Urine samples were collected preoperatively and at 4 hours after surgery for NC test. Urine output, serum creatinine, estimated glomerular filtration rate (eGFR) were also measured. AKI staging was based on kidney disease improving global outcomes (KDIGO) guidelines.
STATISTICAL ANALYSIS
To assess the predictability of NC test for the primary endpoint, area under the receiver operating characteristic curve (ROC), was calculated.
RESULTS
Thirteen patients developed AKI in the study cohort (14.4%) out of which 7 patients (7.8%) developed stage 2/3 AKI and the remaining stage 1 AKI. Baseline renal parameters were similar between AKI and non-AKI group. The area under curve (AUC) of NC test at 4 hours after surgery was 0.60 [95% confidence interval (CI): 0.42-0.77]. Postoperative NC test performed at 4 hours after surgery did not predict AKI in this study population (P = 0.24). There were no significant differences in duration of mechanical ventilation, length of intensive care stay and hospital stay between the two groups (P > 0.05).
CONCLUSION
NephroCheck test performed at 4 hours after surgery did not identify patients at risk for developing AKI following OPCABG surgery.
背景
尿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（IFGBP-7）的定量检测，其商业名称为 NephroCheck™（NC）检测，已被认为是心脏手术体外循环（CPB）后急性肾损伤（AKI）早期检测的有前途的工具。
目的
本研究旨在检验术后 4 小时 NC 检测单次值可预测非体外循环冠状动脉旁路移植术（OPCABG）手术 AKI 的假设。
设置和设计
这项前瞻性单中心研究于 2017 年 12 月至 2018 年 11 月在印度的三级心脏中心进行。
方法
纳入 90 名接受择期 OPCABG 的成年患者。所有患者的麻醉均标准化。术前和术后 4 小时采集尿液样本进行 NC 检测。还测量了尿量、血清肌酐和估算肾小球滤过率（eGFR）。AKI 分期基于肾脏病改善全球结局（KDIGO）指南。
统计分析
为评估 NC 检测对主要终点的预测能力，计算了受试者工作特征曲线（ROC）下面积（AUC）。
结果
研究队列中有 13 名患者发生 AKI（14.4%），其中 7 名患者（7.8%）发生 2/3 期 AKI，其余患者发生 1 期 AKI。AKI 组和非 AKI 组的基线肾脏参数相似。术后 4 小时 NC 检测的 AUC 为 0.60[95%置信区间（CI）：0.42-0.77]。在本研究人群中，术后 4 小时 NC 检测未预测 AKI（P=0.24）。两组之间的机械通气时间、重症监护病房住院时间和住院时间无显著差异（P＞0.05）。
结论
OPCABG 手术后 4 小时进行的 NephroCheck 检测未能识别出发生 AKI 的高危患者。
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