Division of Nephrology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Nephrol. 2024 Dec;39(12):3591-3596. doi: 10.1007/s00467-024-06464-9. Epub 2024 Aug 2.
Cardiopulmonary bypass (CPB) is associated with hemolysis and acute kidney injury (AKI). The study aim was to determine if urine dipstick blood in infants after CPB was associated with AKI and urine neutrophil gelatinase-associated lipocalin (NGAL).
Infants who underwent CPB at a single center were enrolled prospectively between October 2017 and June 2019. Urine samples prior to CPB and 6 h after CPB cessation were analyzed in batch for NGAL and dipstick blood. AKI was defined using creatinine-based KDIGO criteria within 72 h of CPB. Spearman correlation examined associations between urine dipstick blood and NGAL at each time point. Linear regression estimated the associations between urine dipstick blood and log-transformed NGAL 6 h after CPB. Logistic regression estimated associations and compared discrimination between urine dipstick blood and NGAL for predicting AKI.
At baseline, 7/63 samples (11%) had > trace blood. Six hours after CPB, 62/98 samples (63%) had > trace blood and 26% had 3 + (large) blood. In total, 18/98 (18%) with a 6-h post-CPB sample had postoperative AKI. Urine dipstick blood values correlated with urine NGAL 6 h after CPB (r = 0.52, p < 0.01), but not at baseline (r = 0.06, p = 0.66). Those with 3 + (large) blood on urine dipstick had 6 times higher mean NGAL values compared to those with negative/trace blood (mean ratio 6.6, 95%CI 3.1-14.4, p < 0.01). Those with 3 + (large) blood had 8 times higher odds of AKI (OR 7.99, 95%CI 1.5-41.9, p = 0.01).
Urine dipstick blood post CPB may be a simple and inexpensive tool to help predict AKI in infants.
体外循环（CPB）与溶血和急性肾损伤（AKI）有关。本研究旨在确定 CPB 后婴儿的尿液干化学法检测血液是否与 AKI 和尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）有关。
在 2017 年 10 月至 2019 年 6 月期间，在一家单中心前瞻性纳入接受 CPB 的婴儿。在 CPB 前和 CPB 停止后 6 小时，批量分析尿液样本，检测 NGAL 和尿液干化学法。CPB 后 72 小时内，根据基于肌酐的 KDIGO 标准定义 AKI。Spearman 相关分析在每个时间点检测尿液干化学法检测血液与 NGAL 之间的相关性。线性回归估计 CPB 后 6 小时尿液干化学法检测血液与对数转换 NGAL 之间的关系。逻辑回归估计尿液干化学法检测血液和 NGAL 对预测 AKI 的关联和比较判别能力。
在基线时，7/63 份（11%）样本有>微量血液。CPB 后 6 小时，62/98 份（63%）样本有>微量血液，26%有 3+（大量）血液。共有 18/98（18%）份有 CPB 后样本的术后 AKI。CPB 后 6 小时，尿液干化学法检测血液值与尿液 NGAL 呈正相关（r=0.52，p<0.01），但与基线时无相关性（r=0.06，p=0.66）。尿液干化学法检测有 3+（大量）血液的患者，其 NGAL 值平均比阴性/微量血液的患者高 6 倍（平均比值 6.6，95%CI 3.1-14.4，p<0.01）。尿液干化学法检测有 3+（大量）血液的患者，AKI 的几率高 8 倍（OR 7.99，95%CI 1.5-41.9，p=0.01）。
CPB 后尿液干化学法检测血液可能是一种简单且经济的工具，有助于预测婴儿 AKI。
