Plasma Neutrophil Gelatinase-Associated Lipocalin Is Associated With Acute Kidney Injury and Clinical Outcomes in Neonates Undergoing Cardiopulmonary Bypass.
Plasma Neutrophil Gelatinase-Associated Lipocalin Is Associated With Acute Kidney Injury and Clinical Outcomes in Neonates Undergoing Cardiopulmonary Bypass.
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血浆中性粒细胞明胶酶相关脂质运载蛋白与体外循环新生儿的急性肾损伤和临床结果相关。
DOI：
10.1097/pcc.0000000000002035
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Graham,EricM
中科院分区：
文献类型：
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作者：
Schroeder,LukeW;Buckley,JasonR;Stroud,RobertE;Martin,ReneeH;Nadeau,ElizabethK;Barrs,Ryan;Graham,EricM
目的：急性肾损伤是新生儿心脏手术后常见的并发症，与显著的发病率和死亡率相关。本研究的目的是确定血浆中性粒细胞明胶酶相关脂质运载蛋白水平是否与接受体外循环的先天性心脏病新生儿的急性肾损伤和临床结局相关。设计：回顾性单中心观察性研究。设置：三级护理学术医院内的儿科心脏ICU。患者：年龄小于30天的患者接受需要体外循环的心脏手术。干预：无。测量和主要结果：血浆中性粒细胞明胶酶相关脂质运载蛋白在体外循环术后12小时达到峰值，与术前水平相比增加了一倍以上。术前和术后24小时中性粒细胞明胶酶相关脂质运载蛋白水平升高与急性肾损伤相关（r= 0.30，r= 0.49），机械通气时间较长（r= 0.40，r= 0.51），ICU（r= 0.32，r= 0.33）和住院时间（r= 0.28，r= 0.32），与住院总费用（r= 0.35，r= 0.30;所有p值< 0.05）。术前和术后24小时血浆中性粒细胞明胶酶-相关的脂质运载蛋白水平与接受心脏手术的新生儿的急性肾损伤和更差的临床结果相关。血浆中性粒细胞明胶酶相关脂质运载蛋白水平可能在预测术后肾功能不全的风险分层中发挥作用，并提供术后潜在的临床轨迹。
Objectives:Acute kidney injury is a frequent complication following neonatal cardiac surgery and is associated with significant morbidity and mortality. The objectives of this study were to determine if plasma neutrophil gelatinase-associated lipocalin levels were associated with acute kidney injury and clinical outcomes in neonates with congenital heart disease undergoing cardiopulmonary bypass.Design:Retrospective single-center observational study.Setting:A pediatric cardiac ICU within a tertiary-care academic hospital.Patients:Patients age less than 30 days undergoing cardiac surgery requiring cardiopulmonary bypass.Interventions:None.Measurements and Main Results:Plasma neutrophil gelatinase-associated lipocalin peaked at 12 hours postcardiopulmonary bypass and more than doubled compared with preoperative levels. Higher preoperative and 24-hour postoperative neutrophil gelatinase-associated lipocalin levels were associated with acute kidney injury (r= 0.30, r= 0.49), longer duration of mechanical ventilation (r= 0.40, r= 0.51), ICU (r= 0.32, r= 0.33) and hospital lengths of stay (r= 0.28, r= 0.32), and total hospital charges (r= 0.35, r= 0.30; all p values< 0.05).Conclusions:Both preoperative and 24-hour postoperative plasma neutrophil gelatinase-associated lipocalin levels are associated with acute kidney injury and worse clinical outcomes in neonates undergoing cardiac surgery. Plasma neutrophil gelatinase-associated lipocalin levels may have a role in risk stratification for predicting postoperative renal dysfunction as well as providing a potential clinical trajectory in the postoperative period.