Urinary Angiotensinogen and Risk of Severe AKI
Urinary Angiotensinogen and Risk of Severe AKI
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DOI：
10.2215/cjn.06280612
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发表时间：
2013-02-01
影响因子：
9.8
通讯作者：
Arthur, John M.
中科院分区：
文献类型：
--
作者：
Alge, Joseph L.;Karakala, Nithin;Arthur, John M.
阿基的生物标志物可以预测哪些患者在诊断时将发展为严重的肾脏疾病，这将有助于及时干预处于不良结局风险中的人群。设计、设置、参与者和测量液相色谱/串联质谱法用于鉴定心脏手术后发展为阿基的一组患者中的30种潜在的严重阿基的预后尿生物标志物。血管紧张素原具有最好的鉴别特征。结果2008年8月1日至2011年10月6日期间97例心脏手术患者尿血管紧张素原/肌酐比值（uAnCR）预测阿基恶化、急性肾损伤网络（AKIN）3期、需要肾脏替代治疗、样本采集后出院>7天、以及AKIN 2或3期、AKIN 3期或死亡和肾脏替代治疗或死亡的复合结局。当仅在尿样收集时分类为AKIN 1期的患者（n=79）用于分析时，uAnCR的预后预测能力得到改善，其中预测3期阿基或死亡的发展，曲线下面积为0.81。最后，无类别净重新分类的改善表明，除了uAnCR的临床模型，以预测恶化的AM提高了predictive power.Conclusions升高uAnCR与阿基患者的不良结局。这些数据首次证明了血管紧张素原作为心脏手术后阿基的预后生物标志物的实用性。Clin J Am Soc Nephrol 8：184-193，2013. doi：10.2215/CJN.06280612
Background Biomarkers of AKI that can predict which patients will develop severe renal disease at the time of diagnosis will facilitate timely intervention in populations at risk of adverse outcomes.Design, setting, participants, & measurements Liquid chromatography/tandem mass spectrometry was used to identify 30 potential prognostic urinary biomarkers of severe AKI in a group of patients that developed AKI after cardiac surgery. Angiotensinogen had the best discriminative characteristics. Urinary angiotensinogen was subsequently measured by ELISA and its prognostic predictive power was verified in 97 patients who underwent cardiac surgery between August 1, 2008 and October 6, 2011.Results The urine angiotensinogen/creatinine ratio (uAnCR) predicted worsening of AKI, Acute Kidney Injury Network (AKIN) stage 3, need for renal replacement therapy, discharge >7 days from sample collection, and composite outcomes of AKIN stage 2 or 3, AKIN stage 3 or death, and renal replacement therapy or death. The prognostic predictive power of uAnCR was improved when only patients classified as AKIN stage 1 at the time of urine sample collection (n=79) were used in the analysis, among whom it predicted development of stage 3 AKI or death with an area under the curve of 0.81. Finally, category free net reclassification improvement showed that the addition of uAnCR to a clinical model to predict worsening of AM improved the predictive power.Conclusions Elevated uAnCR is associated with adverse outcomes inpatients with AKI. These data are the first to demonstrate the utility of angiotensinogen as a prognostic biomarker of AKI after cardiac surgery. Clin J Am Soc Nephrol 8: 184-193, 2013. doi: 10.2215/CJN.06280612