Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.
School of Life Science, National Taiwan Normal University, Taipei, Taiwan.
Ren Fail. 2024 Dec;46(2):2427161. doi: 10.1080/0886022X.2024.2427161. Epub 2024 Nov 26.
In outpatient settings, it is challenging to exclude acute kidney disease (AKD) based on a single serum creatinine (SCr) measurement. This retrospective study aimed to explore the usefulness of urinary biomarkers and a novel functional biomarker, a spot urine creatinine-to-osmolality ratio (sUCr/Osm), for inferring the absence of AKD.
The cohort was from the ASSESS-AKI Study. 'No AKD' was defined as the absence of a SCr increase ≥ 26.5 μmol/L between the preceding visit and the index visit, with a three-month interval. Urinary neutrophil gelatinase-associated lipocalin (UNGAL) was selected as the representative biomarker out of six known candidates. UNGAL levels < 100 ng/mL indicated a positive test. sUCr/Osm values ≥ 7.07 indicated a positive test.
Of the 1,570 participants, 38.0% were female. The mean age (mean ± SD) was 64.6 ± 13.0 years, and the mean SCr level was 102.5 ± 51.4 μmol/L. The area under the receiver operating characteristic curve for UNGAL in identifying 'No AKD' for all participants was 0.548 (95% confidence interval: 0.495-0.600), whereas that for sUCr/Osm was 0.578 (0.525-0.630). The sensitivity of UNGAL was 0.867 (0.849-0.884), with a positive predictive value of 0.917 (0.902-0.932) and an accuracy of 0.808 (0.788-0.827). The corresponding values of sUCr/Osm were 0.926 (0.912-0.939), 0.906 (0.891-0.921), and 0.845 (0.827-0.863). In individuals whose SCr-derived estimated glomerular filtration rate was < 60 mL/min/1.73 m, sUCr/Osm performed comparably to UNGAL.
Using sUCr/Osm to infer the absence of AKD in outpatients with a single SCr measurement may be as effective as using UNGAL.
在门诊环境中，仅凭单次血清肌酐（SCr）测量排除急性肾损伤（AKD）具有挑战性。本回顾性研究旨在探讨尿生物标志物和一种新的功能性生物标志物，即即时尿肌酐/渗透压比值（sUCr/Osm），用于推断 AKD 不存在的价值。
该队列来自 ASSESS-AKI 研究。“无 AKD”定义为在随访间隔三个月的情况下，与前一次就诊相比，就诊时 SCr 增加≥26.5 μmol/L。选择六种已知候选物中的中性粒细胞明胶酶相关脂质运载蛋白（UNGAL）作为代表性生物标志物。UNGAL 水平<100ng/mL 表示检测阳性。sUCr/Osm 值≥7.07 表示检测阳性。
在 1570 名参与者中，38.0%为女性。平均年龄（平均值±标准差）为 64.6±13.0 岁，平均 SCr 水平为 102.5±51.4μmol/L。在所有参与者中，UNGAL 识别“无 AKD”的受试者工作特征曲线下面积为 0.548（95%置信区间：0.495-0.600），而 sUCr/Osm 的面积为 0.578（0.525-0.630）。UNGAL 的敏感性为 0.867（0.849-0.884），阳性预测值为 0.917（0.902-0.932），准确性为 0.808（0.788-0.827）。sUCr/Osm 的相应值为 0.926（0.912-0.939）、0.906（0.891-0.921）和 0.845（0.827-0.863）。在 SCr 衍生估算肾小球滤过率<60mL/min/1.73m2 的个体中，sUCr/Osm 的表现与 UNGAL 相当。
在门诊患者中，使用 sUCr/Osm 推断单次 SCr 测量时 AKD 不存在，其效果可能与 UNGAL 相当。
