Free Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury After On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled Trial.
Free Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury After On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled Trial.
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游离血红蛋白比率作为体外循环心脏手术后急性肾损伤的新生物标志物：一项随机对照试验的二次分析。
DOI：
10.1213/ane.0000000000005381
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发表时间：
2021-06-01
影响因子：
5.7
通讯作者：
Berra L
中科院分区：
文献类型：
--
作者：
Hu J;Rezoagli E;Zadek F;Bittner EA;Lei C;Berra L
体外循环（CPB）心脏手术与术后急性肾损伤（阿基）的高风险相关。由于目前诊断策略的局限性，我们试图确定游离血红蛋白（fHb）比率（即，CPB结束时的fHb水平除以基线fHb）可以预测体外循环心脏手术后的阿基。这是一项随机对照试验的二次分析，该试验比较了一氧化氮（干预）与氮（对照）对心脏手术后阿基的影响（NCT 01802619）。对照组中纳入了110例成人患者。首先，我们通过多变量分析确定fHb比值是否与阿基相关。其次，我们验证了fHb比率是否可以预测阿基，并且与单独使用尿生物标志物的预测相比，fHb比率的掺入可以在早期阶段提高预测性能。我们进行了限制性三次样条逻辑回归模型的发展。我们确定了预测性能，包括受试者工作特征曲线下面积（AUC）和校准（校准图和准确度，即，正确预测数除以预测总数）。我们还采用AUC检验、似然比检验和净重新分类指数（NRI）来比较竞争模型之间的预测性能（即，fHb比率分别与NGAL、NAG和KIM-1的比较，以及fHb比率与NGAL、NAG和KIM-1的结合与单独的尿生物标志物的比较）。按fHb比值中位数分层的数据显示，fHb比值>2.23的受试者阿基发生率较高（80.0% vs. 49.1%，p=0.001），更需要肾脏替代治疗（10.9% vs. 0%，p=0.036）和更高的住院死亡率（10.9% vs. 0%，p=0.036）。校正预先确定的因素后，fHb比值与阿基相关。fHb比值优于尿生物标志物，最高AUC为0.704（95% CI 0.592-0.804），准确度为0.714（95% CI 0.579-0.804）。结合fHb比率实现了更好的区分（AUC检验，p= 0.012），校准[似然比检验，p<0.001;准确度，0.740（95% CI 0.617-0.832）vs 0.632（95% CI 0.477-0.748）]，且预测增量显著（NRI，0.638，95% CI 0.269-1.008，p<0.001），与单独使用尿生物标志物预测相比。这项探索性、产生假设的回顾性、观察性研究的结果表明，CPB结束时的fHb比值可用作阿基的新型、广泛适用的生物标志物。与仅基于尿生物标志物的预测相比，使用fHb比率可能有助于早期检测阿基。
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a high risk of postoperative acute kidney injury (AKI). Due to limitations of current diagnostic strategies, we sought to determine whether free hemoglobin (fHb) ratio (i.e., levels of fHb at the end of CPB divided by baseline fHb) could predict AKI after on-pump cardiac surgery. This is a secondary analysis of a randomized controlled trial comparing the effect of nitric oxide (intervention) versus nitrogen (control) on AKI after cardiac surgery (NCT01802619). 110 adult patients in the control arm were included. First, we determined whether fHb ratio was associated with AKI via multivariable analysis. Second, we verified whether fHb ratio could predict AKI and incorporation of fHb ratio could improve predictive performance at an early stage, compared with prediction using urinary biomarkers alone. We conducted restricted cubic spline in logistic regression for model development. We determined the predictive performance, including area under the receiver-operating-characteristics curve (AUC) and calibration (calibration plot and accuracy, i.e., number of correct predictions divided by total number of predictions). We also employed AUC test, likelihood ratio test, and net reclassification index (NRI) to compare the predictive performance between competing models (i.e., fHb ratio vs. NGAL, NAG, and KIM-1, respectively, and incorporation of fHb ratio with NGAL, NAG, and KIM-1 vs. urinary biomarkers alone), if applicable. Data stratified by median fHb ratio showed that subjects with an fHb ratio >2.23 presented higher incidence of AKI (80.0% vs. 49.1%, p=0.001), more need of renal replacement therapy (10.9% vs. 0%, p=0.036), and higher in-hospital mortality (10.9% vs. 0%, p=0.036) than subjects with an fHb ratio ≤2.23. fHb ratio was associated with AKI after adjustment for pre-established factors. fHb ratio outperformed urinary biomarkers with the highest AUC of 0.704 (95% CI 0.592-0.804) and accuracy of 0.714 (95% CI 0.579-0.804). Incorporation of fHb ratio achieved better discrimination (AUC test, p= 0.012), calibration [likelihood ratio test, p<0.001; accuracy, 0.740 (95% CI 0.617-0.832) versus 0.632 (95% CI 0.477-0.748)], and significant prediction increment (NRI, 0.638, 95% CI 0.269-1.008, p<0.001) at an early stage, compared with prediction using urinary biomarkers alone. Results from this exploratory, hypothesis-generating retrospective, observational study shows that fHb ratio at the end of CPB might be used as a novel, widely applicable biomarker for AKI. The use of fHb ratio might help for an early detection of AKI, compared with prediction based only on urinary biomarkers.
影响因子：
2.1
作者：
Ried M;Puehler T;Haneya A;Schmid C;Diez C
通讯作者：
Diez C