Repulsive guidance cue semaphorin 3A in urine predicts the progression of acute kidney injury in adult patients from a mixed intensive care unit
Repulsive guidance cue semaphorin 3A in urine predicts the progression of acute kidney injury in adult patients from a mixed intensive care unit
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DOI：
10.1093/ndt/gft414
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发表时间：
2014-01-01
影响因子：
6.1
通讯作者：
Ramesh, Ganesan
中科院分区：
文献类型：
--
作者：
Doi, Kent;Noiri, Eisei;Ramesh, Ganesan
在重症监护环境中预测急性肾损伤（阿基）的发展具有挑战性。本研究采用单中心前瞻性队列研究方法，首次评价了semaphorin 3A在异质性重症监护病房（ICU）人群中诊断阿基的可靠性。除了五种尿生物标志物L-型脂肪酸结合蛋白（L-FABP），中性粒细胞明胶酶相关脂质运载蛋白（NGAL），IL-18，白蛋白和N-乙酰-β-D-氨基葡萄糖苷酶（NAG），尿semaphorin 3A在重症监护病房（ICU）入院时测定。其中，131例患者（39例）根据步枪标准诊断为阿基，66例患者在ICU入院后诊断为阿基（迟发性阿基）。84例阿基患者在1周观察期间显示严重程度恶化（阿基进展）。尽管L-FABP、NGAL和IL-18在检测已确立的阿基中显示出比脑信号蛋白3A显著更高的曲线下面积（AUC）-受试者工作特征（ROC）值，但与其他五种生物标志物相比，脑信号蛋白3A能够以相似的AUC-ROC值检测迟发型阿基和阿基进展[已确立的AKI的AUC-ROC（95 CI）为0.64（0.560.71），迟发型阿基0.71（0.640.78），阿基进展0.71（0.640.77）]。在非进展性阿基中，尿脑信号蛋白3A没有增加，而其他生物标志物升高，无论是否进一步进展。最后，脓毒症对脑信号蛋白3A没有任何影响，而其他尿生物标志物随着脓毒症而增加。Semaphorin 3A是一种新的阿基生物标志物，与其他阿基生物标志物相比，它可能对阿基进展具有独特的预测作用。
Predicting the development of acute kidney injury (AKI) in the critical care setting is challenging. Although several biomarkers showed somewhat satisfactory performance for detecting established AKI even in a heterogeneous disease-oriented population, identification of new biomarkers that predict the development of AKI accurately is urgently required.A single-center prospective observational cohort study was undertaken to evaluate for the first time the reliability of the newly identified biomarker semaphorin 3A for AKI diagnosis in heterogeneous intensive care unit populations. In addition to five urinary biomarkers of L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), IL-18, albumin and N-acetyl--d-glucosaminidase (NAG), urinary semaphorin 3A was measured at intensive care unit (ICU) admission.Three hundred thirty-nine critically ill adult patients were recruited for this study. Among them, 131 patients (39) were diagnosed with AKI by the RIFLE criteria and 66 patients were diagnosed as AKI at post-ICU admission (later-onset AKI). Eighty-four AKI patients showed worsening severity during 1 week observation (AKI progression). Although L-FABP, NGAL and IL-18 showed significantly higher area under the curve (AUC)-receiver operating characteristic (ROC) values than semaphorin 3A in detecting established AKI, semaphorin 3A was able to detect later-onset AKI and AKI progression with similar AUC-ROC values compared with the other five biomarkers [AUC-ROC (95 CI) for established AKI 0.64 (0.560.71), later-onset AKI 0.71 (0.640.78), AKI progression 0.71 (0.640.77)]. Urinary semaphorin 3A was not increased in non-progressive established AKI, while the other biomarkers were elevated regardless of further progression. Finally, sepsis did not have any impact on semaphorin 3A while the other urinary biomarkers were increased with sepsis. Semaphorin 3A is a new biomarker of AKI which may have a distinct predictive use for AKI progression when compared with other AKI biomarkers.