Postoperative Biomarkers Predict Acute Kidney Injury and Poor Outcomes after Pediatric Cardiac Surgery
Postoperative Biomarkers Predict Acute Kidney Injury and Poor Outcomes after Pediatric Cardiac Surgery
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DOI：
10.1681/asn.2010111163
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发表时间：
2011-09-01
影响因子：
13.6
通讯作者：
Krawczeski, Catherine D.
中科院分区：
文献类型：
--
作者：
Parikh, Chirag R.;Devarajan, Prasad;Krawczeski, Catherine D.
急性肾损伤（阿基）通常发生在小儿心脏手术后，并与不良结局相关。生物标志物可能有助于预测或早期识别阿基，可能增加治疗干预的机会。在这里，我们进行了一项前瞻性、多中心队列研究，涉及311名接受先天性心脏病手术的儿童，以评估尿IL-18、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）或血浆NGAL的早期术后测量是否可以识别哪些患者会发生阿基和其他不良后果。尿IL-18和尿及血浆NGAL水平在术后6小时内达到峰值。严重阿基定义为住院期间透析或血清肌酐加倍，53名参与者在术后中位2天发生。术后首次尿IL-18和尿NGAL水平与严重阿基密切相关。多变量校正后，与最低五分位数相比，尿IL-18和尿NGAL最高五分位数分别与阿基的几率高6.9倍和4.1倍相关。尿IL-18和尿NGAL水平升高与住院时间、重症监护室时间和机械通气时间延长相关。尿IL-18和尿NGAL诊断重度阿基的准确性中等，曲线下面积分别为0.72和0.71。通过净重新分类改善和综合区分改善测量，这些尿液生物标志物的添加改善了单独临床模型的风险预测。总之，在接受心脏手术的儿童中，尿IL-18和尿NGAL（而非血浆NGAL）与随后的阿基和不良结局相关。
Acute kidney injury (AKI) occurs commonly after pediatric cardiac surgery and associates with poor outcomes. Biomarkers may help the prediction or early identification of AKI, potentially increasing opportunities for therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 311 children undergoing surgery for congenital cardiac lesions to evaluate whether early postoperative measures of urine IL-18, urine neutrophil gelatinase-associated lipocalin (NGAL), or plasma NGAL could identify which patients would develop AKI and other adverse outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. Severe AKI, defined by dialysis or doubling in serum creatinine during hospital stay, occurred in 53 participants at a median of 2 days after surgery. The first postoperative urine IL-18 and urine NGAL levels strongly associated with severe AKI. After multivariable adjustment, the highest quintiles of urine IL-18 and urine NGAL associated with 6.9- and 4.1-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine NGAL levels associated with longer hospital stay, longer intensive care unit stay, and duration of mechanical ventilation. The accuracy of urine IL-18 and urine NGAL for diagnosis of severe AKI was moderate, with areas under the curve of 0.72 and 0.71, respectively. The addition of these urine biomarkers improved risk prediction over clinical models alone as measured by net reclassification improvement and integrated discrimination improvement. In conclusion, urine IL-18 and urine NGAL, but not plasma NGAL, associate with subsequent AKI and poor outcomes among children undergoing cardiac surgery.