Rule Out Acute Kidney Injury in the Emergency Department With a Urinary Dipstick.
Rule Out Acute Kidney Injury in the Emergency Department With a Urinary Dipstick.
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排除急诊室中急性肾脏损伤，并用尿尺。
DOI：
10.1016/j.ekir.2020.09.006
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发表时间：
2020-11
影响因子：
6
通讯作者：
Barasch J
中科院分区：
文献类型：
--
作者：
Stevens JS;Xu K;Corker A;Gopal TS;Sayan OR;Geraghty EP;Yaeh AM;Kosuri YD;Burton JR;Lincoln SV;Callahan MP;Breheney RK;Beenken AS;Gamino JN;Felman AE;Gehani A;Giordano HA;Gozali A;Guerrero Herrera EF;Hatcher BA;Kheir LA;Li Y;Mitsui EK;Nha JI;Sayan AT;Spaiser SJ;Arumugam S;Sia SK;King KL;Mohan S;Barasch J
急性肾损伤的识别依赖于血清肌酐(Scr)，这是一种时间分辨率较低的功能标记物，对细胞损伤的敏感性和特异性也有限。相比之下，肾脏损伤的尿液生物标记物有可能实时检测细胞应激和损伤。为了检测肾脏对损伤的反应，我们测试了一种侧向流动试纸，它测量了一种名为中性粒细胞明胶酶相关脂钙蛋白(NGAL)的尿蛋白。对进入纽约市急诊科并随后住院治疗的479名患者(最终队列N=426)进行了尿液分析。比色法的发展具有很高的评价者间可靠性(88%的符合率)，并与传统的酶联免疫吸附测定(ρ=0.732，P=0.0001)相关。在符合急性肾损伤网络(AKI)SCR标准的14%的队列中，67%的患者出现一过性(2天)SCR升高，33%的患者出现持续(2天)的SCR升高。比较Scr持续、短暂或未检测到变化的患者的预后，发现尿NGAL试纸具有较高的特异性和阴性预测值(高与低中读数，敏感性=0.55，特异性=0.91，阳性预测值=0.24，NPV=0.97，χ_2=20.39，P<0.001)。我们表明，床边uNGAL试纸的引入可以通过识别没有肾小管损伤的个体来进行准确的分诊。在一个缩短住院时间和基于孤立的SCR测量做出快速决定的时代，通过试纸实时排除肾脏损伤将特别有用，以克服SCR的追溯、不敏感和非特异性属性。
The identification of acute injury of the kidney relies on serum creatinine (SCr), a functional marker with poor temporal resolution as well as limited sensitivity and specificity for cellular injury. In contrast, urinary biomarkers of kidney injury have the potential to detect cellular stress and damage in real time. To detect the response of the kidney to injury, we have tested a lateral flow dipstick that measures a urinary protein called neutrophil gelatinase-associated lipocalin (NGAL). Analysis of urine was performed in a prospective cohort of 479 patients (final cohort N = 426) entering an emergency department in New York City and subsequently admitted for inpatient care. Colorimetric development had high interrater reliability (88% concordance rate) and correlated with traditional enzyme-linked immunosorbent assay (ELISA) measurements (ρ = 0.732, P < .0001). Of the 14% of the cohort who met Acute Kidney Injury Network (AKIN) SCr criteria for acute kidney injury (AKI), 67% demonstrated transient (<2 days) and 33% demonstrated sustained (>2 days) elevation of SCr. Comparing the outcomes of patients with sustained versus transient or undetectable changes in SCr revealed that the urinary NGAL (uNGAL) dipstick had high specificity and negative predictive value (NPV) (high- vs. low-intermediate readings, sensitivity = 0.55, specificity = 0.91, positive predictive value = 0.24, NPV = 0.97, χ2 = 20.39, P < 0.001). We show that the introduction of a bedside uNGAL dipstick permits accurate triage by identifying individuals who do not have tubular injury. In an era of shortening length of stay and rapid decisions based on isolated SCr measurements, real-time exclusion of kidney injury by a dipstick will be particularly useful to overcome the retrospective, insensitive, and nonspecific attributes of SCr.
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影响因子：
4.6
作者：
Brown, Jeremiah R.;Kramer, Robert S.;Coca, Steven G.;Parikh, Chirag R.
通讯作者：
Parikh, Chirag R.
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作者：
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影响因子：
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