In PICU acute kidney injury stage 3 or mortality is associated with early excretion of urinary renin
In PICU acute kidney injury stage 3 or mortality is associated with early excretion of urinary renin
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DOI：
10.1038/s41390-021-01592-6
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发表时间：
2021-06-03
影响因子：
3.6
通讯作者：
Li, Yanhong
中科院分区：
文献类型：
--
作者：
Kuai, Yuxian;Huang, Hui;Li, Yanhong
背景尿肾素被认为是预测成人急性肾损伤(AKI)预后的一种新的生物标志物。我们研究的目的是评估尿肾素对危重儿童AKI和儿科重症监护病房(PICU)死亡率的早期预测价值。方法收集PICU患者入院后24 h内的第一份尿样，采用双抗体夹心法测定肾素水平。尿肾素浓度校正为尿肌酐(尿肾素/肌酐比值，uRenCR)。AKI是根据KDIGO标准定义的。结果207例患儿中发生AKI 22例，其中1期6例，2期6例，3期10例，死亡14例。非AKI患儿与AKI3期患儿相比，uRenCR差异有统计学意义(P=0.001)，但与AKI1、2期无显著差异。调整混杂因素后，uRenCR仍与AKI3期及PICU病死率相关。URenCR诊断AKI3期的受试者工作特征曲线下面积为0.805，PICU死亡率为0.801。结论尿肾素与危重患儿AKI分期3期和PICU病死率增加有关。尿肾素被认为是一种新的成人AKI预后生物标志物。儿童和成人在生理和病理生理特征上存在一定的差异。这项研究表明，在危重儿童中，尿肾素与AKI 3期和PICU死亡率的增加有关。在病程早期准确识别有严重肾损伤或高死亡风险的患者，可以增强可用干预措施的有效性，改善患者预后。
Background Urinary renin is proposed to be a novel prognostic biomarker of acute kidney injury (AKI) in adults. The intention of our study was to evaluate the early predictive value of urinary renin for AKI and pediatric intensive care unit (PICU) mortality in critically ill children. Methods The first available urine sample during the first 24 h after admission was collected upon PICU admission for the measurement of renin using ELISA. Urinary renin concentrations were corrected for urinary creatinine (urinary renin-to-creatinine ratio, uRenCR). AKI was defined based on KDIGO criteria. Results Of the 207 children, 22 developed AKI, including 6 with stage 1, 6 with stage 2, and 10 with stage 3, and 14 died during PICU stay. There was a significant difference in uRenCR between non-AKI children and those with AKI stage 3 (P = 0.001), but not with AKI stage 1 or 2. The uRenCR remained associated with AKI stage 3 and PICU mortality after adjustment for potential confounders. The area under the receiver operating characteristic curve of uRenCR for discrimination of AKI stage 3 was 0.805, and PICU mortality was 0.801. Conclusions Urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. ImpactUrinary renin is proposed to be a novel prognostic biomarker of AKI in adult patients. There are some differences between children and adults in physiological and pathophysiological characteristics. This study demonstrated that urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. Accurate identification of patients with severe renal injury or at high risk for mortality early in the disease course could augment the efficacy of available interventions and improve patient outcomes.