Urine YKL-40 is associated with progressive acute kidney injury or death in hospitalized patients.
Urine YKL-40 is associated with progressive acute kidney injury or death in hospitalized patients.
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DOI：
10.1186/1471-2369-15-133
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发表时间：
2014-08-15
期刊：
影响因子：
2.3
通讯作者：
Parikh CR
中科院分区：
文献类型：
--
作者：
Hall IE;Stern EP;Cantley LG;Elias JA;Parikh CR
肾移植中的翻译研究表明，几丁质酶3样1基因产物YKL-40在急性肾损伤（阿基）和修复中起重要作用，但缺乏关于天然人肾脏尿液中该蛋白的数据。这是一项针对根据阿基网络血清肌酐标准临床定义的阿基患者的单中心、前瞻性观察性队列的辅助研究。我们确定了阿基第一天采集的尿液中YKL-40 ≥ 5 ng/ml（单独或联合中性粒细胞明胶酶相关脂质运载蛋白（NGAL））与临床重要复合结局（进展至更高阿基分期和/或院内死亡）的相关性。YKL-40在所有249例患者中均可检测到，但尿液浓度远低于先前测量的死亡供体肾移植受者。72例患者（29%）发生进展或在医院死亡，YKL-40 ≥ 5 ng/ml的结果校正比值比（95%置信区间）为3.4（1.5-7.7）。将YKL-40添加到用于预测结果的临床模型中导致29%的持续净重新分类改善（P = 0.04）。在基于上四分位数NGAL浓度的结局高风险患者中，YKL-40进一步将队列分为中风险组和极高风险组。尿YKL-40与住院患者的阿基进展和/或死亡相关，并改善临床确定的风险重新分类。将YKL-40与其他阿基标志物（如NGAL）相结合可能会进一步描述进展风险，但还需要进行更多的研究来确定YKL-40是否具有普遍适用性，并确定其与阿基长期结局的相关性。
A translational study in renal transplantation suggested YKL-40, a chitinase 3-like-1 gene product, plays an important role in acute kidney injury (AKI) and repair, but data are lacking about this protein in urine from native human kidneys. This is an ancillary study to a single-center, prospective observational cohort of patients with clinically-defined AKI according to AKI Network serum creatinine criteria. We determined the association of YKL -40 ≥ 5 ng/ml, alone or combined with neutrophil gelatinase-associated lipocalin (NGAL), in urine collected on the first day of AKI with a clinically important composite outcome (progression to higher AKI stage and/or in-hospital death). YKL-40 was detectable in all 249 patients, but urinary concentrations were considerably lower than in previously measured deceased-donor kidney transplant recipients. Seventy-two patients (29%) progressed or died in-hospital, and YKL-40 ≥ 5 ng/ml had an adjusted odds ratio (95% confidence interval) for the outcome of 3.4 (1.5-7.7). The addition of YKL-40 to a clinical model for predicting the outcome resulted in a continuous net reclassification improvement of 29% (P = 0.04). In patients at high risk for the outcome based on NGAL concentrations in the upper quartile, YKL-40 further partitioned the cohort into moderate-risk and very high-risk groups. Urine YKL-40 is associated with AKI progression and/or death in hospitalized patients and improves clinically determined risk reclassification. Combining YKL-40 with other AKI biomarkers like NGAL may further delineate progression risk, though additional studies are needed to determine whether YKL-40 has general applicability and to define its association with longer-term outcomes in AKI.