Fu You, Zhang Ze, He Cong, Jia Lijing, Ge Chen, Long Ling, Bai Yinxiang, Zhang Na, Shen Limin, Du Quansheng, Zhao Heling
Department of Intensive Care Unit, Hebei General Hospital, Shijiazhuang City, China.
Ren Fail. 2024 Dec;46(2):2438855. doi: 10.1080/0886022X.2024.2438855. Epub 2024 Dec 15.
The purpose of this study was to evaluate the performance of urinary C-C motif chemokine ligand 14 (CCL14) and the renal resistive index (RI) in predicting persistent AKI in unselected critically ill patients.
This prospective observational study was conducted in a tertiary hospital's general intensive care unit (ICU). Consecutive adults who were admitted to the ICU were enrolled, with a primary endpoint of AKI lasting 48 h or longer. Urinary CCL14 was evaluated upon inclusion, and the renal RI was determined within 12 h of ICU admission. The individual discriminative ability of urinary CCL14 and the renal RI to predict persistent AKI was evaluated by the area under the receiver operating characteristic curve (AUC).
Overall, 166 patients were included, of whom 56 had persistent AKI. Urinary CCL14 showed good ability to predict persistent AKI, with an AUC of 0.817. However, the overall performance of the renal RI was fair, with an AUC of 0.739. Forty-nine patients presented with mild AKI at inclusion, and the values of CCL14 were significantly lower than those of patients with moderate or severe AKI (0.205 [0.125-0.300] vs. 0.302 [0.157-0.501]; = 0.034). In the subgroup analysis, although the diagnostic performance of CCL14 was excellent in patients with moderate or severe AKI, it was fair in patients with mild AKI [AUC = 0. 738; 95% confidence interval (CI) 0.593-0.853].
Urinary CCL14 was an excellent predictor of persistent AKI in patients with moderate or severe AKI, but its performance was not good in patients with mild AKI. The renal RI cannot discriminate between transient and persistent AKI.
本研究旨在评估尿C-C基序趋化因子配体14（CCL14）和肾阻力指数（RI）在预测未选择的危重症患者持续性急性肾损伤（AKI）中的表现。
这项前瞻性观察性研究在一家三级医院的综合重症监护病房（ICU）进行。纳入连续入住ICU的成年人，主要终点为持续48小时或更长时间的AKI。入组时评估尿CCL14，并在入住ICU后12小时内测定肾RI。通过受试者工作特征曲线下面积（AUC）评估尿CCL14和肾RI预测持续性AKI的个体鉴别能力。
总共纳入166例患者，其中56例有持续性AKI。尿CCL14显示出良好的预测持续性AKI的能力，AUC为0.817。然而，肾RI的总体表现一般，AUC为0.739。49例患者入组时表现为轻度AKI，其CCL14值明显低于中度或重度AKI患者（0.205[0.125 - 0.300]对0.302[0.157 - 0.501]；P = 0.034）。在亚组分析中，尽管CCL14在中度或重度AKI患者中的诊断性能优异，但在轻度AKI患者中表现一般[AUC = 0.738；95%置信区间（CI）0.593 - 0.853]。
尿CCL14是中度或重度AKI患者持续性AKI的优秀预测指标，但在轻度AKI患者中表现不佳。肾RI无法区分短暂性和持续性AKI。
