Vandenberghe Wim, De Loor Jorien, Francois Katrien, Vandekerckhove Kristof, Herck Ingrid, Vande Walle Johan, Peperstraete Harlinde, Bové Thierry, De Wolf Daniël, Nuytinck Lieve, De Waele Jan J, Meyer Evelyne, Hoste Eric A J
Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium.
Department of Cardiac Surgery, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium.
Diagnostics (Basel). 2023 Mar 9;13(6):1047. doi: 10.3390/diagnostics13061047.
Acute kidney injury (AKI) is common after pediatric cardiac surgery (CS). Several urine biomarkers have been validated to detect AKI earlier. The objective of this study was to evaluate urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck as predictors for AKI ≥ 1 in pediatric CS after 48 h and AKI ≥ 2 after 12 h. Pediatric patients (age < 18 year; body weight ≥ 2 kg) requiring CS were prospectively included. Urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck were measured during surgery and intensive care unit (ICU) stay and corrected for urine dilution. One hundred and one pediatric patients were included. AKI ≥ 1 within 48 h after ICU admission occurred in 62.4% and AKI ≥ 2 within 12 h in 30.7%. All damage biomarkers predicted AKI ≥ 1 within 48 h after ICU admission, when corrected for urine dilution: CHI3L1 (AUC-ROC: 0.642 (95% CI, 0.535-0.741)), NGAL (0.765 (0.664-0.848)), TIMP-2 (0.778 (0.662-0.868)), IGFBP7 (0.796 (0.682-0.883)), NephroCheck (0.734 (0.614-0.832)). Similarly, AKI ≥ 2 within 12 h was predicted by all damage biomarkers when corrected for urine dilution: uCHI3L1 (AUC-ROC: 0.686 (95% CI, 0.580-0.780)), NGAL (0.714 (0.609-0.804)), TIMP-2 (0.830 (0.722-0.909)), IGFBP7 (0.834 (0.725-0.912)), NephroCheck (0.774 (0.658-0.865)). After pediatric cardiac surgery, the damage biomarkers urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck reliably predict AKI after correction for urine dilution.
急性肾损伤（AKI）在小儿心脏手术（CS）后很常见。几种尿液生物标志物已被证实可更早地检测出AKI。本研究的目的是评估尿液中的几丁质酶3样蛋白1（CHI3L1）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、基质金属蛋白酶组织抑制因子2（TIMP-2）、胰岛素样生长因子结合蛋白7（IGFBP7）和NephroCheck，作为小儿CS术后48小时内AKI≥1级及12小时内AKI≥2级的预测指标。前瞻性纳入需要进行CS的小儿患者（年龄<18岁；体重≥2kg）。在手术期间及重症监护病房（ICU）住院期间测量尿液中的CHI3L1、NGAL、TIMP-2、IGFBP7和NephroCheck，并对尿液稀释进行校正。共纳入101例小儿患者。ICU入院后48小时内AKI≥1级的发生率为62.4%，12小时内AKI≥2级的发生率为30.7%。校正尿液稀释后，所有损伤生物标志物均可预测ICU入院后48小时内AKI≥1级：CHI3L1（曲线下面积-ROC：0.642（95%可信区间，0.535-0.741））、NGAL（0.765（0.664-0.848））、TIMP-2（0.778（0.662-0.868））、IGFBP7（0.796（0.682-0.883））、NephroCheck（0.734（0.614-
