Urinary Matrix Metalloproteinase-7 and Prediction of AKI Progression Post Cardiac Surgery
Urinary Matrix Metalloproteinase-7 and Prediction of AKI Progression Post Cardiac Surgery
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尿基质金属蛋白酶 7 和心脏手术后 AKI 进展的预测
DOI：
10.1155/2019/9217571
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发表时间：
2019-11-19
期刊：
影响因子：
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通讯作者：
Yang, Xiaobing
中科院分区：
文献类型：
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作者：
Fang, Fan;Luo, Weihong;Yang, Xiaobing
目的心脏手术后进行性急性肾损伤（AKI）高风险患者的早期检测仍然是一个重大挑战。我们的目的是评估尿基质金属蛋白酶-7 （uMMP-7）和其他已报道的生物标志物在预测AKI术后住院期间进展方面的效用。方法：我们对121例心脏手术后1期或2期AKI的成年患者进行了一项前瞻性、多中心队列研究。在AKI临床诊断时测量uMMP-7和其他已报道的生物标志物（il -18， uNGAL和UACR）。主要终点是心脏手术后AKI的进展，定义为AKI阶段恶化（1期至2期或3期或从2期至3期）。结果在调整临床危险因素后，在AKI诊断时，uMMP‐7浓度为7.8 μg/g的患者与uMMP‐7 < 2.7 μg/g的患者相比，AKI进展的风险是后者的8倍。uMMP-7预测进行性AKI的AUC为0.80，表现良好。联合使用uMMP-7和IL-18预测进行性AKI的AUC最高。在临床危险因素模型中加入uMMP-7可显著改善AKI进展的风险再分类。结论在AKI临床诊断时检测uMMP-7，是预测心脏手术后AKI进展的一种新的生物标志物。将uMMP-7添加到临床危险因素模型中可以作为一种无创方法来识别心脏手术后进行性AKI的高风险亚群。
Aims Early detection of patients at high risk for progressive acute kidney injury (AKI) after cardiac surgery remains a major challenge. We aim to evaluate the utility of urinary matrix metalloproteinase-7 (uMMP-7) and other reported biomarkers for predicting AKI progression during postoperative hospital stay. Methods We conducted a prospective, multicenter cohort study in 121 adult patients with stage 1 or 2 AKI after cardiac surgery. uMMP-7 and other well-reported biomarkers (uIL-18, uNGAL, and UACR) were measured at time of AKI clinical diagnosis. The primary outcome is the progression of AKI after cardiac surgery, defined as worsening of AKI stage (stage 1 to either stage 2 or stage 3 or from stage 2 to stage 3). Results A level of uMMP‐7 > 7.8 μg/g Cr at time of AKI diagnosis conveyed an 8-fold risk of AKI progression as compared to those with uMMP‐7 < 2.7 μg/g after adjusting for clinical risk factors. The performance of uMMP-7 for predicting progressive AKI was good with an AUC of 0.80. The combination of uMMP-7 and IL-18 produces the greatest AUC for predicting progressive AKI. Addition of uMMP-7 to the clinical risk factor model significantly improved risk reclassification for AKI progression. Conclusions uMMP-7, measured at time of AKI clinical diagnosis, is a novel biomarker for predicting the progression of AKI after cardiac surgery. Adding uMMP-7 to the clinical risk factor model may be used as a noninvasive approach to identify a subpopulation that is at high risk for progressive AKI after cardiac surgery.