Plasma microRNA-21 for the early prediction of acute kidney injury in patients undergoing major cardiac surgery
Plasma microRNA-21 for the early prediction of acute kidney injury in patients undergoing major cardiac surgery
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DOI：
10.1093/ndt/gfw007
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发表时间：
2016-05-01
影响因子：
6.1
通讯作者：
Moellmann, Helge
中科院分区：
文献类型：
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作者：
Gaede, Luise;Liebetrau, Christoph;Moellmann, Helge
急性肾损伤（阿基）是心脏大手术后的一种并发症，与较高的发病率和死亡率相关。MicroRNA-21（miR-21）已被描述为阿基的早期生物标志物。我们研究了miR-21是否能预测心脏手术后阿基和长期死亡率，研究对象为115例接受心脏大手术的患者。在体外循环前、体外循环后4 h、体外循环后1、4和7 d测定血清肌酐。术后阿基的诊断是根据国际肾脏疾病：改善阿基的全球结局定义进行的。术前和术后4 h分别测定血清胱抑素C和miR-21水平。通过定量RT-PCR测定miR-21，并将其标准化为来自秀丽隐杆线虫的miRNA-39。中位随访时间为2.9年，阿基发生率为36.5%（n = 42）。发生心脏手术相关阿基（CSA-AKI）的患者的基线miR-21显著低于未发生CSA-AKI的患者[0.27（四分位距，IQR，0.14-0.30）vs 0.44（IQR 0.25-0.75）; P < 0.01]。基线miR-21预测CSA-AKI 2/3期，曲线下面积为0.701 [95%置信区间（CI）0.59-0.82; P = 0.007]。基线miR-21 < 0.31显示CSA-AKI 2/3期的风险比为3.11（95% CI：1.33-11.26）。在2.9年的随访中，阿基2/3期患者的死亡率（50%对10%; P = 0.0001）和透析率（27%对11%; P = 0.038）显著更高。该预测值可能有助于术前风险评估和围手术期诊断和治疗。
Acute kidney injury (AKI) is a complication after major cardiac surgery that is associated with higher rates of morbidity and mortality. MicroRNA-21 (miR-21) has been described as an early biomarker for AKI. We investigated whether miR-21 is predictive of AKI and long-term mortality after cardiac surgery.Consecutive patients (n = 115) undergoing major cardiac surgery were included. Serum creatinine was measured prior to, 4 h after, and 1, 4 and 7 days after extracorporeal circulation. Diagnosis of post-operative AKI was made in accordance with the international Kidney Disease: Improving Global Outcomes definition of AKI. Serum cystatin C and miR-21 were measured prior to and 4 h after surgery. miR-21 was determined by quantitative RT-PCR and was normalized to miRNA-39 from Caenorhabditis elegans. The median follow-up time was 2.9 years.AKI occurred in 36.5% (n = 42) of all patients. Baseline miR-21 was significantly lower in patients developing cardiac surgery-associated AKI (CSA-AKI) than in patients without CSA-AKI [0.27 (interquartile range, IQR, 0.14-0.30) versus 0.44 (IQR 0.25-0.75); P < 0.01]. Baseline miR-21 predicted CSA-AKI Stage 2/3 with an area under the curve of 0.701 [95% confidence interval (CI) 0.59-0.82; P = 0.007]. Baseline miR-21 < 0.31 showed a hazard ratio of 3.11 (95% CI: 1.33-11.26) for CSA-AKI Stage 2/3. Patients with AKI Stage 2/3 had a significantly higher mortality (50 versus 10%; P = 0.0001) and dialysis rate (27 versus 11%; P = 0.038) within the 2.9-year follow-up.Our results indicate that miR-21 has the potential to identify patients at higher risk for CSA-AKI. This predictive value might be helpful in pre-procedural risk assessment and peri-procedural diagnosis and treatment.