Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit
Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit
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DOI：
10.1681/asn.2005030236
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发表时间：
2005-10-01
影响因子：
13.6
通讯作者：
Edelstein, CL
中科院分区：
文献类型：
--
作者：
Parikh, CR;Abraham, E;Edelstein, CL
在急性肾损伤(AKI)患者中，血清肌酐不是反映肾功能的理想指标。以往的研究表明，人AKI患者尿液中IL-18水平升高。因此，对尿IL-18是否是AKI的早期诊断标志物进行了研究。在急性呼吸窘迫综合征(ARDS)网络试验中进行嵌套病例对照研究。AKI被定义为在ARDS研究登记的前6天内，血清肌酐至少增加50%。在ARDS试验研究的第0、1和3天，共收集了来自52例患者和86名对照患者的400份尿样。对数据进行横断面分析，并根据AKI发生前的时间进行分析。AKI患者发病前24、48 h尿IL-18中位数与对照组比较差异有统计学意义。在多变量分析中，在调整了人口学、脓毒症、急性生理学评估和慢性健康评估(APACHE)III评分、血肌酐和尿量后，尿IL-18值可预测24和48岁以后AKI的发生。尿IL-18水平100pg/ml与未来24小时发生AKI的几率增加6.5(95%可信区间2.1~20.4)相关。在诊断性能测试中，尿IL-18在受试者操作特征曲线下的面积为73%，可预测未来24小时的AKI。存活与死亡之间的尿IL-18值也有显著差异(P<；0.05)，多因素分析显示，0d的尿IL-18值是一个独立的死亡预测因子。尿IL-18水平可作为AKI的早期诊断指标。尿液IL-18水平也可以预测重症监护病房中ARDS患者的死亡率。
Serum creatinine is not an ideal marker of renal function in patients with acute kidney injury (AKI). Previous studies demonstrated that urinary IL-18 is increased in human AKI. Thus, whether urine IL-18 is an early diagnostic marker of AKI was investigated. A nested case-control study was performed within the Acute Respiratory Distress Syndrome (ARDS) Network trial. AKI was defined as an increase in serum creatinine by at least 50% within the first 6 d of ARDS study enrollment. A total of 400 urine specimens that were collected on study days 0, 1, and 3 of the ARDS trial were available from 52 case patients and 86 control patients. The data were analyzed in a cross-sectional manner and according to the time before development of AKI. The median urine IL-18 levels were significantly different at 24 and 48 It before AKI in case patients as compared with control patients. On multivariable analysis, urine IL-18 values predicted development of AKI 24 and 48 It later after adjustment for demographics, sepsis, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) III score, serum creatinine, and urine output. Urine IL-18 levels of >100 pg/ml are associated with increased odds of AKI of 6.5 (95% confidence interval 2.1 to 20.4) in the next 24 h. On diagnostic performance testing, urine IL-18 demonstrates an area under the receiver operating characteristic curve of 73% to predict AKI in the next 24 h. The urine IL-18 values were also significantly different between survivors and nonsurvivors (P < 0.05), and on multivariable analysis, the urine IL-18 value on day 0 is an independent predictor of mortality. Urinary IL-18 levels can be used for the early diagnosis of AKI. Urine IL-18 levels also predict the mortality of patients who have ARDS and are in the intensive care unit.