Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery.
Urinary cystatin C as an early biomarker of acute kidney injury following adult cardiothoracic surgery.
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DOI：
10.1038/ki.2008.341
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发表时间：
2008-10
影响因子：
19.6
通讯作者：
Murray, Patrick T.
中科院分区：
文献类型：
--
作者：
Koyner, Jay L.;Bennett, Michael R.;Worcester, Elaine M.;Ma, Qing;Raman, Jai;Jeevanandam, Valluvan;Kasza, Kristen E.;Connor, Michael F. O';Konczal, David J.;Trevino, Sharon;Devarajan, Prasad;Murray, Patrick T.
关键词：
有必要开发心脏手术后急性肾损伤的早期生物标志物，其存在会增加发病率和死亡率。血浆半胱氨酸蛋白酶抑制剂C（CyC）以及血浆和尿液中的神经胶质酶相关脂质运载蛋白（NGAL）已被证明比危重患者的血浆肌酐变化更早地检测到肾损伤。为了确定尿CyC水平作为衡量肾损伤的实用性，我们前瞻性地收集了72名接受择期心脏手术的成人的血浆和尿液进行分析。急性肾损伤定义为术后前72小时内血浆肌酐或肾脏替代治疗升高25%或以上。血浆CyC和NGAL在术后前6小时内不是急性肾损伤的有用预测因子。相比之下，与没有损伤的患者相比，34例后来发生急性肾损伤的患者的尿CyC和NGAL均升高。入ICU时尿NGAL和入ICU后6 h尿CyC水平对急性肾损伤的预测最有价值。由术后前6小时内达到的最大尿CyC组成的复合时间点优于所有单个时间点。我们的研究表明，尿CyC和NGAL在成人心脏手术后急性肾损伤的早期诊断中优于传统和新型血浆标记物上级。
There is a need to develop early biomarkers of acute kidney injury following cardiac surgery, where morbidity and mortality are increased by its presence. Plasma cystatin C (CyC) and plasma and urine Neutrophil Gelatinase Associated Lipocalin (NGAL) have been shown to detect kidney injury earlier than changes in plasma creatinine in critically ill patients. In order to determine the utility of urinary CyC levels as a measure of kidney injury, we prospectively collected plasma and urine from 72 adults undergoing elective cardiac surgery for analysis. Acute kidney injury was defined as a 25% or greater increase in plasma creatinine or renal replacement therapy within the first 72 hours following surgery. Plasma CyC and NGAL were not useful predictors of acute kidney injury within the first 6 hours following surgery. In contrast, both urinary CyC and NGAL were elevated in the 34 patients who later developed acute kidney injury, compared to those with no injury. The urinary NGAL at the time of ICU arrival and the urinary CyC level 6 hours after ICU admission were most useful for predicting acute kidney injury. A composite time point consisting of the maximum urinary CyC achieved in the first 6 hours following surgery outperformed all individual time points. Our study suggests that urinary CyC and NGAL are superior to conventional and novel plasma markers in the early diagnosis of acute kidney injury following adult cardiac surgery.
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