Urine NGAL predicts severity of acute kidney injury after cardiac surgery: A prospective study
Urine NGAL predicts severity of acute kidney injury after cardiac surgery: A prospective study
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DOI：
10.2215/cjn.04010907
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发表时间：
2008-05-01
影响因子：
9.8
通讯作者：
Devarajan, Prasad
中科院分区：
文献类型：
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作者：
Bennett, Michael;Dent, Catherine L.;Devarajan, Prasad
背景和目标：作者先前已经表明，通过研究ELISA测量的尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是心肺转流术（CPB）后急性肾损伤（AKI）的早期预测生物标志物。在这项研究中，是否NGAL免疫测定开发的标准化临床平台，（ARCHITECT分析仪（R），Abbott Diagnostics Division，Abbott Laboratories，Abbott Park，IL）可以预测CPB测试后的AKI。在一项有136份尿样的初步研究中，（NGAL范围，0.3 - 815 ng/ml）和6个校准标准品（NGAL范围，0至1000 ng/ml），通过研究ELISA和通过ARCHITECT（R）测定的NGAL测量高度相关（r = 0.99）。在随后的研究中，前瞻性地招募了196名接受CPB的儿童，并通过ARCHITECT（R）测定法获得了连续的尿液NGAL测量值。主要结果是AKI，定义为血清肌酐升高>= 50%。结果：99例患者（51%）发生AKI，但使用血清肌酐的诊断延迟了CPB后2 - 3天。相比之下，平均尿NGAL水平在CPB后2小时内增加15倍，在4和6小时增加25倍。对于2小时尿NGAL测量，曲线下面积为0.95，灵敏度为0.82，特异性为0.90，用于使用100 ng/ml的截止值预测AKI。2小时尿NGAL水平与AKI的严重程度和持续时间、住院时间、透析需求和死亡相关。结论：使用ARCHITECT（R）平台可获得尿NGAL的准确测量值。尿NGAL是CPB后AKI严重程度的早期预测生物标志物。
Background and objectives: The authors have previously shown that urine neutrophil gelatinase-associated lipocalin (NGAL), measured by a research ELISA, is an early predictive biomarker of acute kidney injury (AKI) after cardiopulmonary bypass (CPB). In this study, whether an NGAL immunoassay developed for a standardized clinical platform (ARCHITECT analyzer (R), Abbott Diagnostics Division, Abbott Laboratories, Abbott Park, IL) can predict AKI after CPB was tested.Design, setting, participants, & measurements: In a pilot study with 136 urine samples (NGAL range, 0.3 to 815 ng/ml) and 6 calibration standards (NGAL range, 0 to 1000 ng/ml), NGAL measurements by research ELISA and by the ARCHITECT (R) assay were highly correlated (r = 0.99). In a subsequent study, 196 children undergoing CPB were prospectively enrolled and serial urine NGAL measurements obtained by ARCHITECT (R) assay. The primary outcome was AKI, defined as a >= 50% increase in serum creatinine.Results: AKI developed in 99 patients (51%), but the diagnosis using serum creatinine was delayed by 2 to 3 d after CPB. In contrast, mean urine NGAL levels increased 15-fold within 2 h and by 25-fold at 4 and 6 h after CPB. For the 2-h urine NGAL measurement, the area under the curve was 0.95, sensitivity was 0.82, and the specificity was 0.90 for prediction of AKI using a cutoff value of 100 ng/ml. The 2-h urine NGAL levels correlated with severity and duration of AKI, length of stay, dialysis requirement, and death.Conclusions: Accurate measurements of urine NGAL are obtained using the ARCHITECT (R) platform. Urine NGAL is an early predictive biomarker of AKI severity after CPB.