Performance of Kidney Injury Molecule-1 and Liver Fatty Acid-Binding Protein and Combined Biomarkers of AKI after Cardiac Surgery
Performance of Kidney Injury Molecule-1 and Liver Fatty Acid-Binding Protein and Combined Biomarkers of AKI after Cardiac Surgery
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DOI：
10.2215/cjn.10971012
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发表时间：
2013-07-01
影响因子：
9.8
通讯作者：
Coca, Steven G.
中科院分区：
文献类型：
--
作者：
Parikh, Chirag R.;Thiessen-Philbrook, Heather;Coca, Steven G.
背景和目标 AKI 很常见，新型生物标志物可能有助于在术后阶段提供 AKI 的早期诊断和预后。 设计、设置、参与者和测量 这是一项前瞻性、多中心队列研究，涉及 8 个学术医疗中心连续入组的 1219 名成人和 311 名儿童。评估围手术期两种尿液生物标志物——肾损伤分子-1 (KIM-1) 和肝脏脂肪酸结合蛋白 (L-FABP) 的性能，单独或与其他损伤生物标志物联合使用。 AM 被定义为血清肌酐加倍或需要急性透析。 结果 KIM-1 在成人手术后 2 天和儿童手术后 1 天达到峰值，而 L-FABP 在两个年龄组的手术后 6 小时内达到峰值。在多变量分析中，与成人中最低五分位数相比，首次术后 KIM-1 水平的最高五分位数与 AKI 相关，而首次术后 L-FABP 与 AM 无关。在调整其他肾损伤生物标志物（中性粒细胞明胶酶相关脂质运载蛋白和 IL-18）后，KIM-1 和 L-FABP 均与成人或儿童 AKI 没有显着相关性。使用 6 至 12 小时尿液 KIM-1、第 2 天尿液 IL-18 和第 2 天血浆中性粒细胞明胶酶相关脂质运载蛋白检测 AKI 的最高曲线下面积为 0.78，儿童使用 0 至 6 小时尿液 IL-18 和第 2 天尿液 L-FABP 检测的曲线下面积为 0.78。 结论 术后 KIM-1 升高与 AKI 和不良反应相关。成人中的结果，但并不独立于其他 AKI 生物标志物。一组多种生物标志物对 AM 提供了中等程度的区分。
Background and objectives AKI is common and novel biomarkers may help provide earlier diagnosis and prognosis of AKI in the postoperative period.Design, setting, participants, & measurements This was a prospective, multicenter cohort study involving 1219 adults and 311 children consecutively enrolled at eight academic medical centers. Performance of two urine biomarkers, kidney injury molecule-1 (KIM-1) and liver fatty acid-binding protein (L-FABP), alone or in combination with other injury biomarkers during the perioperative period was evaluated. AM was defined as doubling of serum creatinine or need for acute dialysis.Results KIM-1 peaked 2 days after surgery in adults and 1 day after surgery in children, whereas L-FABP peaked within 6 hours after surgery in both age groups. In multivariable analyses, the highest quintile of the first postoperative KIM-1 level was associated with AKI compared with the lowest quintile in adults, whereas the first postoperative L-FABP was not associated with AM. Both KIM-1 and L-FABP were not significantly associated with AKI in adults or children after adjusting for other kidney injury biomarkers (neutrophil gelatinase-associated lipocalin and IL-18). The highest area under the curves achievable for discrimination for AKI were 0.78 in adults using urine KIM-1 from 6 to 12 hours, urine IL-18 from day 2, and plasma neutrophil gelatinaseassociated lipocalin from day 2 and 0.78 in children using urine IL-18 from 0 to 6 hours and urine L-FABP from day 2.Conclusions Postoperative elevations of KIM-1 associate with AKI and adverse outcmes in adults but were not independent of other AKI biomarkers. A panel of multiple biomarkers provided moderate discrimination for AM.