Yilmaz Deniz, Sahin Ezgi, Batar Gizem, Caglayan Koray, Gulturk Emine, Aydin Yoldemir Sengul
Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkiye.
Department of Rheumatology Clinic, Istanbul University Faculty of Medicine, Istanbul, Turkiye.
PLoS One. 2025 Jun 25;20(6):e0327044. doi: 10.1371/journal.pone.0327044. eCollection 2025.
This retrospective cohort study aimed to assess the predictive value of protein fractions obtained from blood and urine protein electrophoresis, along with various clinical and laboratory parameters, for 1-year all-cause mortality in acute kidney injury (AKI) patients. Data were collected from hospitalized patients who had been diagnosed with AKI. Demographics, smoking status, blood and urine electrophoresis results, serum gamma globulin levels, monoclonal gammopathy status, immunofixation results, serum free kappa (κ) and lambda (λ), and urine κ and λ levels were measured in addition to routine biochemistry and complete blood counts. In addition, serum free κ-to-λ ratio and urine κ-to-λ ratio were calculated. The primary endpoint was 1-year all-cause mortality and its association with electrophoresis-obtained data. Among the 295 patients included in the analyses, 65 (22.03%) experienced mortality, with higher mean age (72.75 ± 13.51) compared to the survival group (62.58 ± 16.59) (p < 0.001). Sex distribution showed no significant difference between groups. No significant disparities were observed in electrophoresis parameters and other laboratory values. Multivariable logistic regression showed that high age (OR: 1.038, 95% CI: 1.016-1.062, p = 0.001) and low albumin (OR: 0.450, 95% CI: 0.263-0.770, p = 0.004) were independent predictors of mortality. We find that the evidence gathered in the present study is insufficient to recommend the use of blood and urine protein fractions for diagnostic or prognostic purposes in patients with AKI. Nonetheless, the current data showing some notable variations in urine κ and λ levels suggest that further studies are warranted to explore this relationship.
这项回顾性队列研究旨在评估从血液和尿液蛋白电泳获得的蛋白组分，以及各种临床和实验室参数对急性肾损伤（AKI）患者1年全因死亡率的预测价值。数据收集自被诊断为AKI的住院患者。除了常规生化检查和全血细胞计数外，还测量了人口统计学数据、吸烟状况、血液和尿液电泳结果、血清γ球蛋白水平、单克隆丙种球蛋白病状况、免疫固定结果、血清游离κ（κ）和λ（λ）以及尿液κ和λ水平。此外，还计算了血清游离κ与λ的比值和尿液κ与λ的比值。主要终点是1年全因死亡率及其与电泳获得的数据之间的关联。在纳入分析的295例患者中，65例（22.03%）死亡，与存活组（62.58±16.59）相比，死亡组的平均年龄更高（72.75±13.51）（p<0.001）。两组间性别分布无显著差异。在电泳参数和其他实验室值方面未观察到显著差异。多变量逻辑回归显示，高龄（OR：1.038，95%CI：1.016-1.062，p=0.001）和低白蛋白（OR：0.450，95%CI：0.263-0.770，p=0.004）是死亡率的独立预测因素。我们发现，本研究收集的证据不足以推荐将血液和尿液蛋白组分用于AKI患者的诊断或预后目的。尽管如此，目前的数据显示尿液κ和λ水平存在一些显著差异，这表明有必要进一步研究以探索这种关系。
