Biomarker Predictors of Adverse Acute Kidney Injury Outcomes in Critically Ill Patients: The Dublin Acute Biomarker Group Evaluation Study
Biomarker Predictors of Adverse Acute Kidney Injury Outcomes in Critically Ill Patients: The Dublin Acute Biomarker Group Evaluation Study
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DOI：
10.1159/000500231
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Murray, Patrick T.
中科院分区：
文献类型：
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作者：
McMahon, Blaithin A.;Galligan, Marie;Murray, Patrick T.
背景：都柏林急性生物标记物组评估(Damage)研究是一项前瞻性的双中心观察性研究，调查尿液生物标记物组合在异质成人重症监护病房(ICU)人群中对急性肾损伤(AKI)的诊断和预后评估的应用。本研究的目的是评估系列尿生物标记物测定结合简单的临床模型，是否可以改善生物标记物在严重AKI的诊断预测和临床结果(如死亡和是否需要肾脏替代治疗(RRT))方面的表现。方法：每天收集ICU患者入院后7天的尿液。检测尿生物标志物(中性粒细胞明胶酶相关脂结合蛋白、α-谷胱甘肽S转移酶、pi-谷胱甘肽转移酶、肾损伤分子-1、肝型脂肪酸结合蛋白[L-FABP]、半胱氨酸C、肌酐和白蛋白)水平。尿液生物标志物与AKI模型的临床预测相结合，以确定预测AKI(任何阶段，在ICU入院后2天或7天内)或30天综合临床结果(RRT-或死亡)的能力。结果：共有257例(38%)患者在ICU入院后7天内发生AKI。在发生AKI的患者中，106名(41%)患者在ICU入院后7天内达到3期AKI，整个研究队列中的208名患者(31%)在ICU入院30天内达到住院死亡率或RRT的综合临床终点。在临床模型中加入尿NGAL/白蛋白后，AKI的预测有所改善，尤其是严重的3AKI(曲线下面积从0.87时的0.9p=0.369)和30天后复发或死亡的预测(AUC0.83时为0.79时，p=0.139)。结论：在异质成人ICU人群中，结合疾病严重程度、患者人口统计学和慢性病的临床模型和目前可用的肾功能临床生物标记物可以很好地预测AKI的发展和相关的临床结果。在这个简单的临床模型中加入尿NGAL/白蛋白改善了对严重AKI、RRT需求和死亡的预测，但与单独的临床模型相比，没有统计学或临床意义上的水平。
Background: The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective 2-center observational study investigating the utility of urinary biomarker combinations for the diagnostic and prognostic assessment of acute kidney injury (AKI) in a heterogeneous adult intensive care unit (ICU) population. The objective of this study is to evaluate whether serial urinary biomarker measurements, in combination with a simple clinical model, could improve biomarker performance in the diagnostic prediction of severe AKI and clinical outcomes such as death and need for renal replacement therapy (RRT). Methods: Urine was collected daily from patients admitted to the ICU, for a total of 7 post-admission days. Urine biomarker concentrations (neutrophil gelatinase-associated lipocalin [NGAL], alpha-glutathione S-transferase [GST], pi-GST, kidney injury molecule-1 [KIM-1], liver-type fatty acid-binding protein [L-FABP], Cystatin C, creatinine, and albumin) were measured. Urine biomarkers were combined with a clinical prediction of AKI model, to determine ability to predict AKI (any stage, within 2 days or 7 days of ICU admission), or a 30-day composite clinical outcome (RRT - or death). Results: A total of 257 (38%) patients developed AKI within 7 days of ICU admission. Of those who developed AKI, 106 (41%) patients met stage 3 AKI within 7days of ICU admission and 208 patients of the entire study cohort (31%) met the composite clinical endpoint of in-hospital mortality or RRT within 30 days of ICU admission. The addition of urinary NGAL/albumin to the clinical model modestly improved the prediction of AKI, in particular severe stage 3 AKI (area under the curve [AUC] of 0.9 from 0.87, p = 0.369) and the prediction of 30-day RRT or death (AUC 0.83 from 0.79, p= 0.139). Conclusion: A clinical model incorporating severity of illness, patient demographics, and chronic illness with currently available clinical biomarkers of renal function was strongly predictive of development of AKI and associated clinical outcomes in a heterogeneous adult ICU population. The addition of urinary NGAL/albumin to thissimple clinical model improved the prediction of severe AKI, need for RRT and death, but not at a statistically or clinically significant level, when compared to the clinical model alone.