Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: a multicenter prospective cohort study.
Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: a multicenter prospective cohort study.
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DOI：
10.1016/j.jacc.2011.10.854
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发表时间：
2012-01-17
影响因子：
24
通讯作者：
Barasch, Jonathan
中科院分区：
文献类型：
--
作者：
Nickolas, Thomas L.;Schmidt-Ott, Kai M.;Canetta, Pietro;Forster, Catherine;Singer, Eugenia;Sise, Meghan;Elger, Antje;Maarouf, Omar;Sola-Del Valle, David Antonio;O'Rourke, Matthew;Sherman, Evan;Lee, Peter;Geara, Abdallah;Imus, Philip;Guddati, Achuta;Polland, Allison;Rahman, Wasiq;Elitok, Saban;Malik, Nasir;Giglio, James;El-Sayegh, Suzanne;Devarajan, Prasad;Hebbar, Sudarshan;Saggi, Subodh J.;Hahn, Barry;Kettritz, Ralph;Luft, Friedrich C.;Barasch, Jonathan
本研究旨在确定内源性急性肾损伤（AKI）患者在急诊科分诊时尿液生物标志物的诊断和预后价值。内源性AKI与肾元损伤相关，导致临床预后差。已经提出了几种尿液生物标志物来检测和测量内在AKI。在一项多中心前瞻性队列研究中，在1,635名未选择的急诊科患者入院时测量了5种尿液生物标志物（尿中性粒细胞明胶酶相关脂钙蛋白、肾损伤分子-1、尿肝型脂肪酸结合蛋白、尿白细胞介素-18和胱抑素C）。我们确定了生物标志物是否诊断了内在AKI并预测了住院期间的不良结局。所有生物标志物在内源性AKI中均升高，但尿中性粒细胞明胶酶相关脂钙蛋白最有用（特异性为81%，104-ng/ml临界值为68%），并预测AKI的严重程度和持续时间。内生性AKI与不良住院结果密切相关。尿中性粒细胞明胶酶相关脂钙蛋白和尿肾损伤分子1预测了透析开始或住院期间死亡的复合结局，与传统评估相比，两者都改善了净风险分类。这些生物标志物还确定了入院时血清肌酐水平低的大量亚群，但他们有不良事件的风险。肾脏损害的尿液生物标志物使急诊科的前瞻性诊断和预后分层成为可能。
This study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department. Intrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI. In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase–associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization. All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events. Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.
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影响因子：
19.6
作者：
Ferguson, Michael A.;Vaidya, Vishal S.;Waikar, Sushrut S.;Collings, Fitz B.;Sunderland, Kelsey E.;Gioules, Costas J.;Bonventre, Joseph V.
通讯作者：
Bonventre, Joseph V.
影响因子：
39.2
作者：
Nickolas, Thomas L.;O'Rourke, Matthew J.;Barasch, Jonathan
通讯作者：
Barasch, Jonathan
影响因子：
19.6
作者：
通讯作者：
--
DOI：
10.1097/01.asn.0000088027.54400.c6
发表时间：
2003-10-01
影响因子：
13.6
作者：
Mishra, J;Ma, Q;Devarajan, P
通讯作者：
Devarajan, P
DOI：
10.1016/j.lab.2003.08.001
发表时间：
2004-01-01
期刊：
JOURNAL OF LABORATORY AND CLINICAL MEDICINE
影响因子：
--
作者：
Kamijo, A;Kimura, K;Omata, M
通讯作者：
Omata, M