Urine neutrophil gelatinase-associated lipocalin levels do not improve risk prediction of progressive chronic kidney disease.
Urine neutrophil gelatinase-associated lipocalin levels do not improve risk prediction of progressive chronic kidney disease.
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DOI：
10.1038/ki.2012.458
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发表时间：
2013-05
影响因子：
19.6
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新的生物标志物可能提高我们预测哪些慢性肾脏疾病（CKD）患者有更高的进行性肾功能丧失风险的能力。在CRIC研究中，我们评估了尿中性粒细胞明胶酶相关脂钙蛋白（NGAL）在3386例CKD患者预后预测中的作用。在该队列中，基线平均估计肾小球滤过率（eGFR）为42.4 ml/min/1.73m2；24小时尿蛋白中位数为0.2 gm/天；尿NGAL中位浓度为17.2 ng/mL。在平均3.2年的随访中，有689例eGFR下降一半或发生终末期肾脏疾病。即使考虑到eGFR、蛋白尿和其他已知的CKD进展危险因素，尿NGAL仍然是一个重要的独立危险因素（Cox模型风险比最高至最低四分位数为1.70）。基线尿液NGAL水平与CKD进展风险之间的关联在生物标志物测量的前两年最强。在此时间框架内，将尿液NGAL添加到包括eGFR、蛋白尿和其他CKD进展危险因素的模型中，导致净重分类改善24.7%；但c值几乎保持不变。因此，尽管尿NGAL是不同病因的慢性肾病患者进展的独立危险因素，但它并没有显著改善预后事件的预测。
Novel biomarkers may improve our ability to predict which patients with chronic kidney disease (CKD) are at higher risk for progressive loss of renal function. Here we assessed the performance of urine neutrophil gelatinase-associated lipocalin (NGAL) for outcome prediction in a diverse cohort of 3386 patients with CKD in the CRIC study. In this cohort, the baseline mean estimated glomerular filtration rate (eGFR) was 42.4 ml/min/1.73m2; the median 24-hour urine protein was 0.2 gm/day; and the median urine NGAL concentration was 17.2 ng/mL. Over an average follow-up of 3.2 years, there were 689 cases in which the eGFR was decreased by half or incident end-stage renal disease developed. Even after accounting for eGFR, proteinuria and other known CKD progression risk factors, urine NGAL remained a significant independent risk factor (Cox model hazard ratio 1.70 highest to lowest quartile). The association between baseline urine NGAL levels and risk of CKD progression was strongest in the first two years of biomarker measurement. Within this time frame, adding urine NGAL to a model which included eGFR, proteinuria and other CKD progression risk factors led to net reclassification improvement of 24.7%; but the C-statistic remained nearly identical. Thus, while urine NGAL was an independent risk factor of progression among patients with established CKD of diverse etiology, it did not substantially improve prediction of outcome events.