Casas-Aparicio Gustavo, Caballero-Islas Adrián E, León-Ortiz Antonio, Escamilla-Illescas David, Rueda-Escobedo Yovanna, Ascención-López Carlos, Hernández-Quino Diana, Flores-Vargas Aimee, Sosa-Chombo Jesús, Tolentino-de La Mora Abraham, Saucedo-Pruneda Ana, Piten-Isidro Elvira
Coordinación de Nefrología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Ciudad de México 14080, Mexico.
Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Ciudad de México 14080, Mexico.
J Clin Med. 2025 Apr 17;14(8):2783. doi: 10.3390/jcm14082783.
Major adverse kidney events (MAKEs), including death, persistent AKI (pAKI), and renal replacement therapy, are more common in SARS-CoV-2-related ARDS. Invasive mechanical ventilation (IMV), systemic inflammation, and hemodynamic changes drive this risk. This study examines early IMV settings and urinary kidney biomarkers (UKBs) to better understand the development of MAKEs at 30 days. This prospective, cross-sectional cohort study was conducted in a single center between September and October 2021. This study included adults (≥18 years) diagnosed with ARDS due to SARS-CoV-2, requiring IMV within the first 6 h of admission. Exclusion criteria included a history of chronic kidney disease (CKD) and pregnant women. Initial mechanical ventilator settings were recorded after compliance-guided PEEP titration, and urine samples were collected for the analysis of UKBs at the same time. Our primary and secondary endpoints were to assess risk factors associated with MAKEs at 30 days and pAKI, respectively. The cohort included 45 patients, with a median age of 57.75 (±18.64) years. In total, 32 (71%) developed MAKEs and 22 (48.8%) developed pAKI. MAKEs were associated with older age (adjusted odds ratio (aORs) = 1.23 95% CI: 1.00-1.22; = 0.038) and higher driving pressure (ΔP) (aORs = 1.62, 95% CI:1.01-2.60, = 0.043). Only urinary neutrophil gelatinase-associated lipocalin (uNGal) > 40 ng/mL was associated with pAKI (aORs = 8.54, 95% CI:1.75-41.65, = 0.008). Early ventilator settings, particularly higher ΔP, play a critical role in the development of MAKEs. uN-Gal could enhance the early detection of pAKI, providing opportunities for timely interventions.
主要不良肾脏事件（MAKEs），包括死亡、持续性急性肾损伤（pAKI）和肾脏替代治疗，在与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关的急性呼吸窘迫综合征（ARDS）中更为常见。有创机械通气（IMV）、全身炎症和血流动力学变化增加了这种风险。本研究旨在探讨早期IMV设置和尿肾生物标志物（UKBs），以更好地了解30天时MAKEs的发生情况。这项前瞻性横断面队列研究于2021年9月至10月在一个中心进行。该研究纳入了因SARS-CoV-2诊断为ARDS且在入院后6小时内需要IMV的成年人（≥18岁）。排除标准包括慢性肾脏病（CKD）病史和孕妇。在根据顺应性指导进行呼气末正压（PEEP）滴定后记录初始机械通气设置，并同时收集尿液样本用于分析UKBs。我们的主要和次要终点分别是评估30天时与MAKEs和pAKI相关的危险因素。该队列包括45名患者，中位年龄为57.75（±18.64）岁。共有32名（71%）发生了MAKEs，22名（48.8%）发生了pAKI。MAKEs与年龄较大（调整后的优势比（aORs）=1.23，95%置信区间：1.00-1.22；P=0.038）和较高的驱动压（ΔP）（aORs=1.62，95%置信区间：1.01-2.60，P=0.043）相关。仅尿中性粒细胞明胶酶相关脂质运载蛋白（uNGal）>40 ng/mL与pAKI相关（aORs=8.54，95%置信区间：1.75-41.65，P=0.008）。早期通气设置，尤其是较高的ΔP，在MAKEs的发生中起关键作用。uNGal可提高pAKI的早期检测率，为及时干预提供机会。
