Serum alpha 1-antitrypsin predicts severe acute kidney injury after cardiac surgery
Serum alpha 1-antitrypsin predicts severe acute kidney injury after cardiac surgery
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血清α1-抗胰蛋白酶可预测心脏手术后的严重急性肾损伤
DOI：
10.21037/jtd.2019.12.17
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发表时间：
2019-12-01
影响因子：
2.5
通讯作者：
Ai, Jun
中科院分区：
文献类型：
--
作者：
Du, Songlin;Tian, Jianwei;Ai, Jun
背景：人α1-抗胰蛋白酶(A1AT)参与了缺血性急性肾损伤(AKI)的病理生理过程。为了验证血清A1AT(SA1AT)是体外循环(CPB)后严重AKI的预测因子的假设，我们对201例心脏手术患者进行了前瞻性队列研究。方法：采集血和尿样，分析围手术期sA1AT和其他损伤生物标志物。重度AKI定义为肾脏病改善全球预后(KDIGO)2或3期，总体AKI定义为KDIGO 1、2或3期。结果：91例(45.3%)患者术后发生严重AKI，其中22例(10.9%)术后发生严重AKI。在随后发展为严重AKI的患者中，sA1AT水平在手术后2小时激增，而血清肌酐在手术后12小时达到峰值。术后sA1AT升高与重度AKI的发生独立相关[OR值为1.54(1.17~2.03)；P=0.002]。术后sA1AT水平最高的四分位数与严重AKI风险是最低四分位数的6倍相关。较高的sA1AT水平与在重症监护病房和医院停留的时间较长相关。对于预测重度AKI，CPB后2小时sA1的AUC值达到0.814。结合尿T细胞免疫球蛋白粘蛋白-1和临床模型后，AUC提高到0.923。结论：sA1AT是预测心脏手术后患者发生严重AKI、延长ICU和住院时间的有价值的指标。
Background: Human alpha 1-antitrypsin (A1AT) is involved in the pathophysiological process underlying ischemic acute kidney injury (AKI). To test the hypothesis that serum A1AT (sA1AT) is a predictor for severe AKI after cardiopulmonary bypass (CPB), we conducted a prospective cohort study in 201 patients undergoing cardiac surgery.Methods: We collected blood and urine samples, and analyzed the sA1AT and other injury biomarkers during the perioperative period. Severe AKI is defined as Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3, and overall AKI is defined as KDIGO stage 1, 2, or 3.Results: Ninety-one (45.3%) patients developed overall AKI, and 22 (10.9%) among them developed severe AKI after operation. sA1AT level spiked 2 hours after surgery in patients who subsequently developed severe AKI, while serum creatinine peaked 12 hours after operation. Higher postoperative sA1AT independently correlated to the development of severe AKI [OR, 1.54 (1.17-2.03); P=0.002]. The highest quartile of postoperative sA1AT level was associated with 6-fold higher hazards of severe AKI compared to the lowest quartile. Higher sA1AT levels were correlated with longer stays in the intensive care unit and the hospital. For predicting severe AKI, the AUC of sA1AT 2 hours after CPB reached 0.814. After combining with urine T cell immunoglobulin mucin-1 and clinical model, the AUC improved to 0.923.Conclusions: In summary, sA1AT is a valuable predictor of severe AKI development and prolonged ICU and hospital stays in patients after cardiac surgery.