Ruault Alice, Philipponnet Carole, Brailova Marina, Gamara Fatma, Sapin Vincent, Evrard Bertrand, Calvet Laure, Bonnet Benjamin, Adda Mireille, Souweine Bertrand, Dupuis Claire
CHU Clermont-Ferrand, Service de Réanimation Médicale, Clermont- Ferrand, France.
CHU Clermont-Ferrand, Service de Néphrologie, Clermont-Ferrand, France.
BMC Nephrol. 2025 Jul 1;26(1):294. doi: 10.1186/s12882-025-04267-0.
BACKGROUND: The present study evaluated the diagnostic and prognostic value of biomarkers, including soluble forms of the receptor for advanced glycation end-products (s-RAGE), soluble urokinase plasminogen activator receptor (SuPAR), and others, for the occurrence of early-onset acute kidney injury (EO-AKI), EO-AKI non-recovery, day-90 major adverse kidney events (MAKE-90), and day-90 mortality in critically ill patients with Coronavirus Disease-19 (Covid-19). METHODS: A single-center, prospective study was conducted at the University Hospital of Clermont-Ferrand, France, between March 2020 and February 2021. The study included adult patients suffering from severe pneumonia caused by the SARS-CoV-2 virus, who were admitted to the hospital's intensive care unit. The urinary biomarkers that constituted the focus of the study included SuPAR, liver fatty-acid-binding proteins (L-FABP), urinary tissue inhibitor of metalloprotease-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) ([TIMP-2]*[IGFBP7]). The serum biomarkers that were studied included s-RAGE and inflammatory markers such as interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α. Assessed outcomes included EO-AKI, EO-AKI non-recovery, MAKE-90, and day-90 mortality. A range of statistical methodologies were employed for the analysis. RESULTS: The study comprised a total of 149 patients. The prevalence of EO-AKI was found to be 30.9%. In 56.5% of cases, EO-AKI non-recovery occurred. MAKE-90 was 43.6% and day-90 mortality was 37%. Procalcitonin was found to be associated with EO-AKI, whilst TNF-α was associated with EO-AKI non-recovery. Furthermore, elevated levels of s-RAGE and SuPAR levels were found to be associated with MAKE-90. CONCLUSIONS: In critically ill patients with confirmed diagnosis of COVID-19, the presence of biomarkers had limited predictive value for the occurrence of EO-AKI. However, TNF-α was found to be associated with EO-AKI non-recovery and s-RAGE and SuPAR were associated with an increased risk of day-90 mortality. CLINICAL TRIAL NUMBER: Not applicable.
背景：本研究评估了生物标志物的诊断和预后价值，包括晚期糖基化终末产物受体的可溶性形式（s-RAGE）、可溶性尿激酶型纤溶酶原激活剂受体（SuPAR）等，用于预测新型冠状病毒肺炎（Covid-19）危重症患者早期急性肾损伤（EO-AKI）的发生、EO-AKI未恢复、90天主要不良肾脏事件（MAKE-90）及90天死亡率。 方法：2020年3月至2021年2月在法国克莱蒙费朗大学医院进行了一项单中心前瞻性研究。该研究纳入了因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒引起的严重肺炎而入住医院重症监护病房的成年患者。构成研究重点的尿液生物标志物包括SuPAR、肝脏脂肪酸结合蛋白（L-FABP）、尿金属蛋白酶组织抑制剂-2（TIMP-2）和胰岛素样生长因子结合蛋白7（IGFBP7）（[TIMP-2]*[IGFBP7]）。研究的血清生物标志物包括s-RAGE和炎症标志物，如白细胞介素（IL）-1β、IL-6和肿瘤坏死因子（TNF）-α。评估的结局包括EO-AKI、EO-AKI未恢复、MAKE-90和90天死亡率。采用了一系列统计方法进行分析。 结果：该研究共纳入149例患者。发现EO-AKI的患病率为30.9%。在56.5%的病例中发生了EO-AKI未恢复。MAKE-90为43.6%，90天死亡率为37%。发现降钙素原与EO-AKI相关，而TNF-α与EO-AKI未恢复相关。此外，发现s-RAGE和SuPAR水平升高与MAKE-90相关。 结论：在确诊为COVID-19的危重症患者中，生物标志物的存在对EO-AKI发生的预测价值有限。然而，发现TNF-α与EO-AKI未恢复相关，s-RAGE和SuPAR与90天死亡风险增加相关。 临床试验编号：不适用。
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