Perioperative heart-type fatty acid binding protein is associated with acute kidney injury after cardiac surgery.
Perioperative heart-type fatty acid binding protein is associated with acute kidney injury after cardiac surgery.
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DOI：
10.1038/ki.2015.104
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发表时间：
2015-09
影响因子：
19.6
通讯作者：
TRIBE-AKI Consortium
中科院分区：
文献类型：
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作者：
Schaub JA;Garg AX;Coca SG;Testani JM;Shlipak MG;Eikelboom J;Kavsak P;McArthur E;Shortt C;Whitlock R;Parikh CR;TRIBE-AKI Consortium
急性肾损伤（阿基）是心脏手术后的常见并发症，与更差的结局相关。由于心脏脂肪酸结合蛋白（H-FABP）是一种检测心脏损伤的心肌蛋白，因此我们试图确定血浆H-FABP是否与TRIBE-AKI队列中的阿基相关; TRIBE-AKI队列是一个多中心队列，包含1219例接受心脏手术的阿基高风险患者。关注的主要结局是任何阿基（急性肾损伤网络（AKIN）1期或更高）和重度阿基（AKIN 2期或更高）。次要结局是出院后的长期死亡率。发生阿基的患者术前和术后的H-FABP水平高于未发生阿基的患者。在校正已知阿基风险因素的分析中，首次术后log（H-FABP）与重度阿基相关（校正OR 5.39 [95% CI，2.87-10.11]/单位增加），而术前log（H-FABP）与任何阿基（2.07 [1.48-2.89]）和死亡率（1.67 [1.17-2.37]）相关。在调整血清肌酐（术后首次log（H-FABP））和心脏和肾脏损伤生物标志物（包括脑钠肽、心肌肌钙蛋白-I、白细胞介素-18、肝脂肪酸结合蛋白、肾损伤分子-1和中性粒细胞明胶酶相关脂质运载蛋白）变化后，这些关系持续存在。因此，围手术期血浆H-FABP水平可用于心脏手术后阿基和死亡率的风险分层。
Acute Kidney Injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Since heart fatty acid binding protein (H-FABP) is a myocardial protein that detects cardiac injury, we sought to determine if plasma H-FABP was associated with AKI in the TRIBE-AKI cohort; a multi-center cohort of 1219 patients at high risk for AKI who underwent cardiac surgery. The primary outcomes of interest were any AKI (Acute Kidney Injury Network (AKIN) stage 1 or higher) and severe AKI (AKIN stage 2 or higher). The secondary outcome was long-term mortality after discharge. Patients who developed AKI had higher levels of H-FABP pre- and post-operatively than patients who did not have AKI. In analyses adjusted for known AKI risk factors, first post-operative log(H-FABP) was associated with severe AKI (adjusted OR 5.39 [95% CI, 2.87-10.11] per unit increase), while pre-operative log(H-FABP) was associated with any AKI (2.07 [1.48-2.89]) and mortality (1.67 [1.17-2.37]). These relationships persisted after adjustment for change in serum creatinine (for first postoperative log(H-FABP)) and biomarkers of cardiac and kidney injury, including brain natriuretic peptide, cardiac troponin-I, interleukin-18, liver fatty acid binding protein, kidney injury molecule-1, and neutrophil gelatinase associated lipocalin. Thus, peri-operative plasma H-FABP levels may be used for risk-stratification of AKI and mortality following cardiac surgery.