Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery
Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery
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DOI：
10.2215/cjn.04810908
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发表时间：
2009-05-01
影响因子：
9.8
通讯作者：
Lee, H. Thomas
中科院分区：
文献类型：
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作者：
Han, Won K.;Wagener, Gebhard;Lee, H. Thomas
背景和目标：血清肌酐 (Scr) 不能用于急性肾损伤 (AKI) 的早期诊断。在一项对 90 名接受心脏手术的成人进行的前瞻性研究中，评估了尿肾损伤分子 1 (KIM-1)、N-乙酰基-β-D-氨基葡萄糖苷酶 (NAG) 和中性粒细胞明胶酶相关脂质运载蛋白 (NGAL) 在早期检测术后 AKI 方面的诊断效用。设计、设置、参与者和测量：尿 在术后前 24 小时的 5 个时间点测量 KIM-1、NAG 和 NGAL，并标准化为心脏手术后的尿肌酐浓度。生成受试者工作特征曲线，并比较曲线下面积 (AUC) 来检测术后 AKI 中生物标志物的性能。 结果：36 名患者出现 AKI，定义为术后 72 小时内 Scr 增加 >= 0.3 mg/dl。 KIM-1预测术后即刻和3 h AKI的AUC分别为0.68和0.65； NAG 为 0.61 和 0.63； NGAL 分别为 0.59 和 0.65。与单独的生物标志物相比，结合这三种生物标志物增强了术后 AKI 早期检测的敏感性：三种生物标志物组合的 AUC 分别为 0.75 和 0.78。在 16 名术后早期 AKI 患者中，组合生物标志物的表现甚至更好，AUC 分别为 0.80 和 0.84。 结论：本研究的结果支持，尿液生物标志物组合可以在心脏手术后在 Scr.Clin J Am Soc Nephrol 4: 873-882, 2009 上升之前早期检测到术后 AKI。 10.2215/CJN.04810908
Background and objectives: Serum creatinine (Scr) does not allow for early diagnosis of acute kidney injury (AKI). The diagnostic utility of urinary kidney injury molecule-1 (KIM-1), N-acetyl-beta-D-glucosaminidase (NAG), and neutrophil gelatinase associated lipocalin (NGAL) was evaluated for the early detection of postoperative AKI in a prospective study of 90 adults undergoing cardiac surgery.Designs, setting, participants, & measurements: Urinary KIM-1, NAG, and NGAL were measured at 5 time points for the first 24 h after operation and normalized to the urinary creatinine concentration after cardiac surgery. Receiver-operating characteristic curves were generated and the areas under the curve (AUCs) compared for performance of biomarkers in detection of postoperative AKI.Results: Thirty-six patients developed AKI, defined as an increase in Scr of >= 0.3 mg/dl within 72 h after surgery. The AUCs for KIM-1 to predict AKI immediately and 3 h after operation were 0.68 and 0.65; 0.61 and 0.63 for NAG; and 0.59 and 0.65 for NGAL, respectively. Combining the three biomarkers enhanced the sensitivity of early detection of postoperative AKI compared with individual biomarkers: the AUCs for the three biomarkers combined were 0.75 and 0.78. The performance of combining biomarkers was even better among 16 early postoperative AKI patients with AUCs of 0.80 and 0.84, respectively.Conclusions: The results of this study support that a combination of urinary biomarkers may allow for early detection of postoperative AKI after cardiac surgery before a rise in Scr.Clin J Am Soc Nephrol 4: 873-882, 2009. doi: 10.2215/CJN.04810908