Collett Jason A, Flannery Alexander H, Liu Lucas J, Takeuchi Tomonori, Basile David P, Neyra Javier A
Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky.
Kidney360. 2024 Nov 1;5(11):1623-1632. doi: 10.34067/KID.0000000000000559. Epub 2024 Sep 4.
IL-17A was higher in patients with AKI versus without AKI during hospitalization and up to 1-year postdischarge. IL-17A was higher in patients with progression of kidney disease but not independently associated with subsequent progression of kidney disease.
AKI is associated with increased mortality and new or progressive CKD. Inflammatory cells play an important role in acute organ injury. We previously demonstrated that serum IL-17A levels were significantly elevated in critically ill patients with AKI and independently associated with hospital mortality. We hypothesize that IL-17A levels are elevated in hospitalized patients with AKI at diagnosis, and sustained elevation after discharge is associated with subsequent CKD incidence or progression.
This was an observational convenience sampling study of hospital survivors of stage 2 or 3 AKI and controls without AKI from the Assessment, Serial Evaluation, and Subsequent Sequelae of AKI study. Patients were classified as progression or nonprogression on the basis of a composite of CKD incidence, progression, or ESKD. IL-17A levels were evaluated with S-Plex assay (Meso Scale Discovery) at 0 (during hospitalization), 3, and 12 months postdischarge and analyzed along with clinical and biomarker data up to 84 months after discharge.
Among 171 AKI and 175 non-AKI participants, IL-17A levels were elevated in AKI versus non-AKI patients at 0-, 3-, and 12-month time points ( < 0.05 for all comparisons). Furthermore, IL-17A levels were elevated in the progression versus nonprogression group at the 3- and 12-month time points for outcomes occurring at 3–6 and 12–84 months, respectively ( < 0.05 for both). In adjusted multivariable models, IL-17A levels were not independently associated with progression of kidney disease. IL-17A levels were positively correlated with kidney disease and immune activation biomarkers at all time points ( < 0.001).
IL-17A was higher in patients with AKI versus without AKI during hospitalization and up to 1-year postdischarge. IL-17A was higher in patients with progression of kidney disease after hospitalization, but not independently associated with subsequent progression of kidney disease in fully adjusted models.
在住院期间以及出院后长达1年的时间里，急性肾损伤（AKI）患者的白细胞介素-17A（IL-17A）水平高于无AKI的患者。肾病进展患者的IL-17A水平较高，但与随后的肾病进展无独立相关性。
AKI与死亡率增加以及新发或进行性慢性肾脏病（CKD）相关。炎症细胞在急性器官损伤中起重要作用。我们之前证明，AKI重症患者的血清IL-17A水平显著升高，且与医院死亡率独立相关。我们假设，诊断时AKI住院患者的IL-17A水平升高，出院后持续升高与随后的CKD发病率或进展相关。
这是一项观察性便利抽样研究，研究对象为急性肾损伤评估、系列评估及后续后遗症（AKI-ASSESS）研究中2期或3期AKI的医院幸存者以及无AKI的对照者。根据CKD发病率、进展情况或终末期肾病（ESKD）的综合情况将患者分为进展组或非进展组。在出院时（住院期间）、出院后3个月和12个月，采用S-Plex检测法（Meso Scale Discovery）评估IL-17A水平，并与出院后长达84个月的临床和生物标志物数据一起进行分析。
在171例AKI参与者和175例非AKI参与者中，在0个月、3个月和12个月时间点，AKI患者的IL-17A水平高于非AKI患者（所有比较均P<0.05）。此外，分别在3至6个月和12至84个月出现结局的3个月和12个月时间点，进展组的IL-17A水平高于非进展组（两者均P<0.05）。在调整后的多变量模型中，IL-17A水平与肾病进展无独立相关性。在所有时间点，IL-17A水平与肾病及免疫激活生物标志物呈正相关（P<0.001）。
在住院期间以及出院后长达1年的时间里，AKI患者的IL-17A水平高于无AKI的患者。住院后肾病进展患者的IL-17A水平较高，但在完全调整模型中与随后的肾病进展无独立相关性。
