NGAL/hepcidin-25 ratio and AKI subtypes in patients following cardiac surgery: a prospective observational study.
NGAL/hepcidin-25 ratio and AKI subtypes in patients following cardiac surgery: a prospective observational study.
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DOI：
10.1007/s40620-021-01063-5
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发表时间：
2022-03
影响因子：
3.4
通讯作者：
Haase-Fielitz A
中科院分区：
文献类型：
--
作者：
Elitok S;Devarajan P;Bellomo R;Isermann B;Haase M;Haase-Fielitz A
结合肾功能参数和损伤生物标志物的急性肾损伤（阿基）亚型可能具有预后价值。我们旨在确定中性粒细胞明胶酶相关脂质运载蛋白（NGAL）/铁调素-25比值（NGAL的尿浓度除以铁调素-25）定义的亚型是否与心脏手术患者的预后相关。我们研究了198例高危心脏手术患者。我们将患者分为四组：肾脏疾病改善总体结局（KDIGO）-AKI阴性和NGAL/hepcidin-25比率阴性（无阿基），KDIGO AKI阴性和NGAL/hepcidin-25比率阳性（亚临床阿基），KDIGO AKI阳性和NGAL/hepcidin-25比率阴性（临床阿基），KDIGO AKI阳性和NGAL/hepcidin-25比率阳性（合并阿基）。结果包括住院死亡率（主要）和长期死亡率（次要）。我们确定了127例（61.6%）无阿基患者，13例（6.6%）亚临床患者，40例（20.2%）临床患者和18例（9.1%）合并阿基患者。亚临床阿基患者的院内死亡率是非阿基患者的23倍。合并阿基与无阿基或临床阿基相比，结果更强（比值比（OR）分别为126和39）。调整EuroScore、术中红细胞压积和主动脉阻断时间后，亚临床和合并阿基的院内死亡率仍高于无阿基和临床阿基（调整后OR：28.118，95% CI 1.465-539.703; 3.737，95% CI 1.746-7.998）。考克斯比例风险模型发现，与无阿基相比，生物标志物通知的阿基亚型与长期生存率显著相关（校正OR：汇总亚临床和临床阿基：1.885，95% CI 1.003-3.542;合并阿基：1.792，95% CI 1.367-2.350）。在存在或不存在KDIGO阿基临床标准的情况下，尿NGAL/hepcidin-25-比值似乎可以检测出与病理学相关的阿基亚型。NCT 00672334，clinicaltrials.gov，注册日期：2008年5月6日，https://clinicaltrials.gov/ct2/show/NCT00672334。阿基亚型的定义：亚临床阿基（KDIGO阴性和Ratio阳性）、临床阿基（KDIGO阳性和Ratio阴性）和合并阿基（KDIGO阳性和Ratio阳性），尿NGAL/铁调素-25比值阳性截止值为85%，用于院内死亡。急性肾损伤AUC，曲线下面积。NGAL，中性粒细胞明胶酶相关脂质运载蛋白。KDIGO，肾脏疾病改善全球成果倡议阿基定义。在线版本包含补充材料，可通过10.1007/s40620-021-01063-5获得。
Acute kidney injury (AKI) subtypes combining kidney functional parameters and injury biomarkers may have prognostic value. We aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL)/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of hepcidin-25) defined subtypes are of prognostic relevance in cardiac surgery patients. We studied 198 higher-risk cardiac surgery patients. We allocated patients to four groups: Kidney Disease Improving Global Outcomes (KDIGO)-AKI-negative and NGAL/hepcidin-25 ratio-negative (no AKI), KDIGO AKI-negative and NGAL/hepcidin-25 ratio-positive (subclinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-negative (clinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-positive (combined AKI). Outcomes included in-hospital mortality (primary) and long-term mortality (secondary). We identified 127 (61.6%) patients with no AKI, 13 (6.6%) with subclinical, 40 (20.2%) with clinical and 18 (9.1%) with combined AKI. Subclinical AKI patients had a 23-fold greater in-hospital mortality than no AKI patients. For combined AKI vs. no AKI or clinical AKI, findings were stronger (odds ratios (ORs): 126 and 39, respectively). After adjusting for EuroScore, volume of intraoperative packed red blood cells, and aortic cross-clamp time, subclinical and combined AKI remained associated with greater in-hospital mortality than no AKI and clinical AKI (adjusted ORs: 28.118, 95% CI 1.465–539.703; 3.737, 95% CI 1.746–7.998). Cox proportional hazard models found a significant association of biomarker-informed AKI subtypes with long-term survival compared with no AKI (adjusted ORs: pooled subclinical and clinical AKI: 1.885, 95% CI 1.003–3.542; combined AKI: 1.792, 95% CI 1.367–2.350). In the presence or absence of KDIGO clinical criteria for AKI, the urinary NGAL/hepcidin-25-ratio appears to detect prognostically relevant AKI subtypes. NCT00672334, clinicaltrials.gov, date of registration: 6th May 2008, https://clinicaltrials.gov/ct2/show/NCT00672334. Definition of AKI subtypes: subclinical AKI (KDIGO negative AND Ratio-positive), clinical AKI (KDIGO positive AND Ratio-negative) and combined AKI (KDIGO positive AND Ratio-positive) with urinary NGAL/hepcidin-25 ratio-positive cut-off at 85% specificity for in-hospital death. AKI, acute kidney injury. AUC, area under the curve. NGAL, neutrophil gelatinase-associated lipocalin. KDIGO, Kidney Disease Improving Global Outcomes Initiative AKI definition. The online version contains supplementary material available at 10.1007/s40620-021-01063-5.
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影响因子：
3.4
作者：
Russo E;Esposito P;Taramasso L;Magnasco L;Saio M;Briano F;Russo C;Dettori S;Vena A;Di Biagio A;Garibotto G;Bassetti M;Viazzi F;GECOVID working group
通讯作者：
GECOVID working group
影响因子：
3.3
作者：
Moledina DG;Parikh CR
通讯作者：
Parikh CR
DOI：
10.1016/j.jtcvs.2017.12.056
发表时间：
2018-06-01
影响因子：
6
作者：
Albert, Christian;Albert, Annemarie;Haase-Fielitz, Anja
通讯作者：
Haase-Fielitz, Anja
影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
通讯作者：
Salamon, R
影响因子：
2.3
作者：
Cho E;Kim SC;Kim MG;Jo SK;Cho WY;Kim HK
通讯作者：
Kim HK