尿肝型脂肪酸结合蛋白（L-FABP）在脓毒症相关急性肾损伤的早期检测及预后预测中的作用

Urinary Liver-Type Fatty Acid Binding Protein (L-FABP) in Early Detection and Outcome Prediction of Sepsis-Associated Acute Kidney Injury.

作者信息

Hai Ghi Nguyen, Gia Binh Nguyen, Thanh Hoa Do, Thai Cuong Nguyen, Anh Duc Vu, Duc Anh Duong, Xuan Duong Le

机构信息

108 Military Central Hospital, Hanoi, Vietnam.

Bach Mai Hospital, Hanoi, Vietnam.

出版信息

Arch Acad Emerg Med. 2025 Jan 13;13(1):e26. doi: 10.22037/aaemj.v13i1.2525. eCollection 2025.

DOI:10.22037/aaemj.v13i1.2525

PMID:39958960

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11829237/

Abstract

INTRODUCTION

Acute kidney injury (AKI) is one of the most frequent complications in septic shock cases, and has a high mortality rate. The aim of this study was to determine the value of urinary liver-type fatty acid binding protein (L-FABP) in early detection and outcome prediction of AKI in patients with sepsis and septic shock.

METHODS

This prospective cohort study was conducted on patients who presented to the emergency department (ED) with sepsis or septic shock. Urinary L-FABP levels were measured at the time of admission and patients were classified into AKI and non-AKI groups within 7 days according to the KIDGO Criteria. The screening performance characteristics of urinary L-FABP in early detection of AKI within seven days of admission and need for renal replacement therapy (RRT) were calculated and reported.

RESULTS

212 patients with the mean age of 66.5 ± 16.2 (range 18-99) years were included (60.4% male). 54 (25.5%) patients had sepsis, and septic shock was developed in 158 (74.53%) cases. 143 (67.5%) patients were complicated with AKI. The area under the receiver operating characteristic (ROC) curve (AUC) of urinary L-FABP in early detection of sepsis-associated AKI was 0.94 (95% confidence interval (CI): 0.90 - 0.97), compared to the AUC of 0.64 (95% CI: 0.54-0.74) for serum creatinine. The sensitivity and specificity of urinary L_FABP at its best cutoff point (13.90 μg L-FABP/g Cr) were 89.9% and 86.3%, respectively. The area under the ROC curve of urinary L-FABP in predicting the need for RRT in sepsis-associated AKI patients was 0.74 (95% CI: 0.64-0.85), compared to the AUC of 0.53 (95% CI: 0.41-0.64) for serum creatinine. The sensitivity and specificity of urinary L-FABP at its best cutoff point (22.05 μg L-FABP/g Cr) were 63.6% and 71.4%, respectively.

CONCLUSIONS

It seems that, L-FABP could be considered as a valuable biomarker for early detection and predicting the severity of AKI in septic patients.

摘要

引言

急性肾损伤（AKI）是脓毒性休克病例中最常见的并发症之一，死亡率很高。本研究的目的是确定尿肝型脂肪酸结合蛋白（L-FABP）在脓毒症和脓毒性休克患者AKI早期检测及预后预测中的价值。

方法

本前瞻性队列研究针对因脓毒症或脓毒性休克就诊于急诊科（ED）的患者开展。入院时测定尿L-FABP水平，并根据肾脏疾病改善全球预后（KIDGO）标准在7天内将患者分为AKI组和非AKI组。计算并报告尿L-FABP在入院7天内早期检测AKI及肾脏替代治疗（RRT）需求方面的筛查性能特征。

结果

纳入212例患者，平均年龄66.5±16.2（范围18 - 99）岁（男性占60.4%）。54例（25.5%）患者患有脓毒症，158例（74.53%）发生脓毒性休克。143例（67.5%）患者并发AKI。尿L-FABP在早期检测脓毒症相关性AKI时的受试者操作特征（ROC）曲线下面积（AUC）为0.94（95%置信区间（CI）：0.90 - 0.97），而血清肌酐的AUC为0.64（95% CI：0.54 - 0.74）。尿L_FABP在最佳截断点（13.90μg L-FABP/g肌酐）时的敏感性和特异性分别为89.9%和86.3%。尿L-FABP在预测脓毒症相关性AKI患者RRT需求时的ROC曲线下面积为0.74（95% CI：0.64 - 0.85），而血清肌酐的AUC为0.53（95% CI：0.41 - 0.64）。尿L-FABP在最佳截断点（22.05μg L-FABP/g肌酐）时的敏感性和特异性分别为63.6%和71.4%。