MicroRNA-21 and risk of severe acute kidney injury and poor outcomes after adult cardiac surgery.
MicroRNA-21 and risk of severe acute kidney injury and poor outcomes after adult cardiac surgery.
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DOI：
10.1371/journal.pone.0063390
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Zheng Z
中科院分区：
文献类型：
--
作者：
Du J;Cao X;Zou L;Chen Y;Guo J;Chen Z;Hu S;Zheng Z
心脏手术后严重急性肾损伤（AKI）与不良的临床结果相关。这项研究评估了 miR-21 作为术后 AKI 进展和其他不良结局风险标记的潜在用途。该研究包括 120 名接受心脏手术的成年患者：40 名非 AKI 对照患者、39 名进行性 AKI 患者和 41 名非进行性 AKI 患者。通过定量实时 PCR (RT-qPCR) 评估尿液和血浆中 miR-21 的水平。通过估计受试者工作特征曲线 (AUC) 下的面积来确定 miR-21 水平与 AKI 进展之间的关联。我们证明，AKI 患者尿液和血浆 miR-21 水平上调均与 AKI 进展相关。与已确定的 AKI 相关的尿液和血浆 miR-21 水平的 AUC 分别为 0.68 (95% CI: 0.59–0.78) 和 0.80 (95% CI: 0.73–0.88)。调整临床变量的多元逻辑回归分析表明，尿液和血浆 miR-21 水平对 AKI 进展的预后预测能力分别由 0.81（95%CI：0.72-0.91）和 0.83（95%CI：0.74-0.92）的 AUC 表示。尿液和血浆 miR-21 水平还预测术后肾脏替代治疗 (RRT) 的需要、急性肾损伤网络 (AKIN) 3 期 AKI 的发展、30 天住院死亡率以及住院或 ICU 住院时间延长。尿液 miR-21 是比血浆 miR-21 更好的结果预测因子，与 AKI 进展和其他不良结果较高（1.4 至 2.6 倍）的未调整比值比相关。尿液和血浆 miR-21 与严重 AKI 和心脏手术的其他不良术后结果相关，表明它们有可能用作预后标志物。
Severe acute kidney injury (AKI) after cardiac surgery is associated with poor clinical outcomes. This study evaluated the potential use of miR-21 as a risk marker for postoperative AKI progression and other poor outcomes. The study included 120 adult patients undergoing cardiac surgery: 40 non-AKI controls, 39 patients with progressive AKI, and 41 with non-progressive AKI. Urine and plasma levels of miR-21 were assessed by quantitative real-time PCR (RT-qPCR). Associations between miR-21 levels and AKI progression were determined by estimating areas under receiver operating characteristic curves (AUC). We demonstrated that up-regulated urine and plasma levels of miR-21 in patients with AKI were both associated with AKI progression. The AUCs for urine and plasma levels of miR-21 associated with established AKI were 0.68 (95%CI: 0.59–0.78) and 0.80 (95%CI: 0.73–0.88), respectively. Multiple logistic regression analysis, adjusting for clinical variables, indicated that the prognostic predictive power of urine and plasma miR-21 levels for AKI progression were represented by AUCs of 0.81 (95%CI: 0.72–0.91) and 0.83 (95%CI: 0.74–0.92), respectively. Urinary and plasma miR-21 levels also predicted the need for postoperative renal replacement therapy (RRT), development of Acute Kidney Injury Network (AKIN) stage 3 AKI, 30-day in-hospital mortality and prolonged stay in hospital or ICU. Urine miR-21 was a better outcome predictor than plasma miR-21, being associated with higher (1.4- to 2.6-fold) unadjusted odds ratio for progression of AKI and other poor outcomes. Urinary and plasma miR-21 are associated with severe AKI and other poor postoperative outcomes of cardiac surgery, indicating their potential use as prognostic markers.
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