Combination of Two Urinary Biomarkers Predicts Acute Kidney Injury After Adult Cardiac Surgery
Combination of Two Urinary Biomarkers Predicts Acute Kidney Injury After Adult Cardiac Surgery
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DOI：
10.1016/j.athoracsur.2011.10.048
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发表时间：
2012-02-01
影响因子：
4.6
通讯作者：
Noiri, Eisei
中科院分区：
文献类型：
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作者：
Katagiri, Daisuke;Doi, Kent;Noiri, Eisei
背景迄今为止，尚未对成人心脏手术后急性肾损伤（阿基）的尿L型脂肪酸结合蛋白（L-FABP）进行评价。本研究旨在评估由尿L-FABP和N-乙酰-β-D-氨基葡萄糖苷酶（NAG）组成的生物标志物组，这是一种更成熟的肾损伤尿液标志物，用于成人心脏手术后患者的阿基诊断。本研究前瞻性评价了77例在2家综合医院接受心脏手术的成人患者。在手术前、手术后到达重症监护室时（0小时）、到达后4小时和12小时测量尿L-FABP和NAG。根据急性肾损伤网络标准诊断阿基。在77例患者中，28例患者（36.4%）在术后发生阿基。尿L-FABP和NAG显著升高。然而，受试者操作特征（ROC）分析显示，生物标志物的性能具有统计学显著性，但对于临床转化是有限的（L-FABP在4小时的ROC曲线下面积[AUC-ROC]为0.72，NAG为0.75）。尿L-FABP敏感性高，NAG检测阿基特异性高。因此，我们组合了这2种生物标志物，这表明该组合组可以比单独的生物标志物测量更高的准确度检测阿基（AUC-ROC 0.81）。此外，与单独使用临床模型进行预测相比，该生物标志物组显著改善了阿基风险预测。当尿L-FABP和NAG相结合时，即使在成人心脏手术后阿基的异质性人群中，它们也可以充分检测阿基。将具有不同灵敏度和特异性的2种标志物组合提供了提高生物标志物诊断性能的合理策略。(Ann Thorac Surg 2012;93：577-83）（C）2012年，胸外科医师协会
Background. Urinary L-type fatty acid-binding protein (L-FABP) has not been evaluated for adult post-cardiac surgery acute kidney injury (AKI) to date. This study was undertaken to evaluate a biomarker panel consisting of urinary L-FABP and N-acetyl-beta-D-glucosaminidase (NAG), a more established urinary marker of kidney injury, for AKI diagnosis in adult post-cardiac surgery patients.Methods. This study prospectively evaluated 77 adult patients who underwent cardiac surgery at 2 general hospitals. Urinary L-FABP and NAG were measured before surgery, at intensive care unit arrival after surgery (0 hours), 4, and 12 hours after arrival. The AKI was diagnosed by the Acute Kidney Injury Network criteria.Results. Of 77 patients, 28 patients (36.4%) developed AKI after surgery. Urinary L-FABP and NAG were significantly increased. However, receiver operating characteristic (ROC) analysis revealed that the biomarkers' performance was statistically significant but limited for clinical translation (area under the curve of ROC [AUC-ROC] for L-FABP at 4 hours 0.72 and NAG 0.75). Urinary L-FABP showed high sensitivity and NAG detected AKI with high specificity. Therefore, we combined these 2 biomarkers, which revealed that this combination panel can detect AKI with higher accuracy than either biomarker measurement alone (AUC-ROC 0.81). Moreover, this biomarker panel improved AKI risk prediction significantly compared with predictions made using the clinical model alone.Conclusions. When urinary L-FABP and NAG are combined, they can detect AKI adequately, even in a heterogeneous population of adult post-cardiac surgery AKI. Combining 2 markers with different sensitivity and specificity presents a reasonable strategy to improve the diagnostic performance of biomarkers. (Ann Thorac Surg 2012;93:577-83) (C) 2012 by The Society of Thoracic Surgeons