Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study.
Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study.
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血浆中性粒细胞明胶酶相关的Lipocalin可预测小儿心脏手术后的急性肾脏损伤，发病率和死亡率：一项前瞻性不受控制的队列研究。
DOI：
10.1186/cc6192
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Devarajan P
中科院分区：
文献类型：
--
作者：
Dent CL;Ma Q;Dastrala S;Bennett M;Mitsnefes MM;Barasch J;Devarajan P
急性肾损伤（阿基）是体外循环（CPB）的常见并发症。早期生物标志物的缺乏削弱了我们及时干预的能力。我们之前在一个小的患者队列中显示，使用研究酶联免疫吸附试验测量的血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是CPB后阿基的早期预测生物标志物。在这项研究中，我们在一个更大的队列中测试了即时NGAL设备是否可以预测CPB后的阿基。首先，在包括40个血浆样品（NGAL范围60至730 ng/ml）和12个校准标准品（NGAL范围0至1，925 ng/ml）的横截面初步研究中，通过酶联免疫吸附测定和通过Triage® NGAL装置（Biosite Inc.，San Diego，CA，USA）高度相关（r = 0.94）。其次，在随后的前瞻性非对照队列研究中，入组了120例接受CPB的儿童。在基线时和CPB后24小时内以频繁的间隔收集血浆，并使用Triage® NGAL装置分析NGAL。主要结局为阿基，定义为血清肌酐升高50%或以上。45例患者（37%）发生阿基，但使用血清肌酐的诊断延迟了CPB后2 - 3天。相比之下，平均血浆NGAL水平在CPB后2小时内增加了3倍，并在研究期间保持显著升高。多因素分析显示，CPB后2 h血浆NGAL是阿基最强的独立预测因子（β = 0.004，P < 0.0001）。对于2小时血浆NGAL测量，使用150 ng/ml的截止值预测阿基的曲线下面积为0.96，灵敏度为0.84，特异性为0.94。术后2小时血浆NGAL水平与肌酐变化（r = 0.46，P < 0.001）、阿基持续时间（r = 0.57，P < 0.001）和住院时间（r = 0.44，P < 0.001）密切相关。12小时血浆NGAL与死亡率（r = 0.48，P = 0.004）和上述所有发病率指标密切相关。使用即时护理Triage® NGAL装置获得血浆NGAL的准确测量。血浆NGAL是儿科CPB后阿基、发病率和死亡率的早期预测生物标志物。
Acute kidney injury (AKI) is a frequent complication of cardiopulmonary bypass (CPB). The lack of early biomarkers has impaired our ability to intervene in a timely manner. We previously showed in a small cohort of patients that plasma neutrophil gelatinase-associated lipocalin (NGAL), measured using a research enzyme-linked immunosorbent assay, is an early predictive biomarker of AKI after CPB. In this study we tested whether a point-of-care NGAL device can predict AKI after CPB in a larger cohort. First, in a cross-sectional pilot study including 40 plasma samples (NGAL range 60 to 730 ng/ml) and 12 calibration standards (NGAL range 0 to 1,925 ng/ml), NGAL measurements by enzyme-linked immunosorbent assay and by Triage® NGAL Device (Biosite Inc., San Diego, CA, USA) were highly correlated (r = 0.94). Second, in a subsequent prospective uncontrolled cohort study, 120 children undergoing CPB were enrolled. Plasma was collected at baseline and at frequent intervals for 24 hours after CPB, and analyzed for NGAL using the Triage® NGAL device. The primary outcome was AKI, which was defined as a 50% or greater increase in serum creatinine. AKI developed in 45 patients (37%), but the diagnosis using serum creatinine was delayed by 2 to 3 days after CPB. In contrast, mean plasma NGAL levels increased threefold within 2 hours of CPB and remained significantly elevated for the duration of the study. By multivariate analysis, plasma NGAL at 2 hours after CPB was the most powerful independent predictor of AKI (β = 0.004, P < 0.0001). For the 2-hour plasma NGAL measurement, the area under the curve was 0.96, sensitivity was 0.84, and specificity was 0.94 for prediction of AKI using a cut-off value of 150 ng/ml. The 2 hour postoperative plasma NGAL levels strongly correlated with change in creatinine (r = 0.46, P < 0.001), duration of AKI (r = 0.57, P < 0.001), and length of hospital stay (r = 0.44, P < 0.001). The 12-hour plasma NGAL strongly correlated with mortality (r = 0.48, P = 0.004) and all measures of morbidity mentioned above. Accurate measurements of plasma NGAL are obtained using the point-of-care Triage® NGAL device. Plasma NGAL is an early predictive biomarker of AKI, morbidity, and mortality after pediatric CPB.
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影响因子：
39.2
作者：
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