Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury
Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury
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DOI：
10.7326/0003-4819-148-11-200806030-00003
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发表时间：
2008-06-03
影响因子：
39.2
通讯作者：
Barasch, Jonathan
中科院分区：
文献类型：
--
作者：
Nickolas, Thomas L.;O'Rourke, Matthew J.;Barasch, Jonathan
背景：单次血清肌酐测定不能区分急性肾损伤与慢性肾病或肾前氮血症。目的：检测尿中性粒细胞明胶酶相关脂钙蛋白（NGAL）和其他尿蛋白检测急性肾损伤的敏感性和特异性。设计：前瞻性队列研究。地点：纽约哥伦比亚大学医学中心急诊科。参与者：635例急性肾损伤、肾前氮质血症、慢性肾病或肾功能正常的住院患者。测量：急性肾损伤的诊断基于RIFLE（风险、损伤、衰竭、丧失和终末期）标准，并由对实验测量不知情的研究人员分配。免疫印迹法测定尿NGAL，酶测法测定n -乙酰- β - d -氨基葡萄糖苷酶（NAG），免疫比浊法测定α(1)-微球蛋白和α(1)-酸性糖蛋白，Jaffe动力学反应测定血清肌酐。治疗医生无法获得实验测量结果。结果：急性肾损伤患者尿NGAL均值较其他肾功能组显著升高（肌酐为416 μ g/g [SD， 387]; P = 0.001）。在临界值为130 μ g/g肌酐时，NGAL检测急性损伤的敏感性和特异性分别为0.900 （95% CI, 0.73 ~ 0.98）和0.995 (CI, 0.990 ~ 1.00)，阳性和阴性似然比分别为181.5 （CI, 58.33 ~ 564.71）和0.10 (CI, 0.03 ~ 0.29)；这些值优于NAG、α(1)-微球蛋白、α(1)-酸性糖蛋白、钠排泄量和血清肌酐。在多元logistic回归中，尿NGAL水平可高度预测临床结果，包括肾脏病咨询、透析和入住重症监护病房（优势比24.71 [CI， 7.69至79.42]）。局限性：所有患者来自单一中心。很少进行肾脏活检。结论：尿NGAL的单一测量有助于区分急性损伤与正常功能、肾前氮质血症和慢性肾脏疾病，并预测不良的住院预后。
Background: A single serum creatinine measurement cannot distinguish acute kidney injury from chronic kidney disease or prerenal azotemia.Objective: To test the sensitivity and specificity of a single measurement of urinary neutrophil gelatinase-associated lipocalin (NGAL) and other urinary proteins to detect acute kidney injury in a spectrum of patients.Design: Prospective cohort study.Setting: Emergency department of Columbia University Medical Center, New York, New York.Participants: 635 patients admitted to the hospital with acute kidney injury, prerenal azotemia, chronic kidney disease, or normal kidney function.Measurements: Diagnosis of acute kidney injury was based on the RIFLE (risk, injury, failure, loss, and end-stage) criteria and assigned by researchers who were blinded to experimental measurements. Urinary NGAL was measured by immunoblot, N-acetyl-beta-D-glucosaminidase (NAG) by enzyme measurement, alpha(1)-microglobulin and alpha(1)-acid glycoprotein by immunonephelometry, and serum creatinine by Jaffe kinetic reaction. Experimental measurements were not available to treating physicians.Results: Patients with acute kidney injury had a significantly elevated mean urinary NGAL level compared with the other kidney function groups (416 mu g/g creatinine [SD, 387]; P = 0.001). At a cutoff value of 130 mu g/g creatinine, sensitivity and specificity of NGAL for detecting acute injury were 0.900 (95% CI, 0.73 to 0.98) and 0.995 (CI, 0.990 to 1.00), respectively, and positive and negative likelihood ratios were 181.5 (CI, 58.33 to 564.71) and 0.10 (CI, 0.03 to 0.29); these values were superior to those for NAG, alpha(1)-microglobulin, alpha(1)-acid glycoprotein, fractional excretion of sodium, and serum creatinine. In multiple logistic regression, urinary NGAL level was highly predictive of clinical outcomes, including nephrology consultation, dialysis, and admission to the intensive care unit (odds ratio, 24.71 [CI, 7.69 to 79.42]).Limitations: All patients came from a single center. Few kidney biopsies were performed.Conclusion: A single measurement of urinary NGAL helps to distinguish acute injury from normal function, prerenal azotemia, and chronic kidney disease and predicts poor inpatient outcomes.