Physiologic risk factors for early acute kidney injury in severely injured patients.
Physiologic risk factors for early acute kidney injury in severely injured patients.
复制标题
严重受伤患者早期急性肾损伤的生理危险因素。
DOI：
10.4149/bll_2020_127
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
R. Záhorec
中科院分区：
文献类型：
--
作者：
P. Sklienka;J. Máca;J. Neiser;F. Burša;P. Ševčík;M. Frelich;N. Petejová;Z. Švagera;H. Tomášková;R. Záhorec
背景
评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对严重损伤患者早期急性肾损伤（阿基）发展的预测价值。组织缺氧、全身性炎症和横纹肌溶解的创伤相关生理标志物在阿基发展中的时间依赖性作用的确定。
方法
81名成年患者在受伤后连续8天接受阿基筛查。在损伤后24小时（T1）、48小时（T2）和96小时（T3）研究血浆NGAL、乳酸、白细胞介素-6、降钙素原和肌红蛋白的动脉水平。
结果
阿基发生率为32.1%。阿基患者年龄较大，但未观察到损伤严重程度的显著差异。与非AKI组相比，阿基组在T1、T2和T3时的NGAL水平显著更高。仅在T2时，阿基组中的乳酸水平显著更高，并且在T2和T3时，阿基组中的IL-6水平显著更高。与非AKI组相比，阿基组在T1、T2和T3时的降钙素原和肌红蛋白水平显著较高。在所有限定的时间点，发现血浆NGAL与所有筛选的生理因素之间呈正相关。
结论
钝性创伤后阿基的发展非常复杂且涉及多个因素。全身炎症反应的激活和横纹肌溶解（高浓度肌红蛋白）与阿基的发生密切相关。在发生创伤后阿基的患者中，受伤后的血液NGAL水平显著较高。血浆NGAL、乳酸盐、降钙素原、白细胞介素-6和肌红蛋白有可能成为创伤后阿基风险分层和预测的有用参数（表1）。6，参考文献40）。
BACKGROUND
The evaluation of the predictive value of the neutrophil gelatinase-associated lipocalin (NGAL) for an early acute kidney injury (AKI) development in severely injured patients. Determination of the time-dependent roles of trauma-related physiologic markers of tissue hypoxia, systemic inflammation and rhabdomyolysis in AKI development.
METHODS
81 adult patients were screened for the presence of AKI for eight consecutive days following the injury. Arterial levels of plasma NGAL, lactate, interleukin-6, procalcitonin, and myoglobin were investigated at 24 hours (T1), 48 hours (T2), and 96 hours (T3) after the injury.
RESULTS
The incidence of AKI was 32.1 %. Patients with AKI were older, but no significant difference in injury severity was observed. NGAL levels were significantly higher in the AKI group at T1, T2, and T3 when compared to the non-AKI group. Lactate levels were significantly higher in the AKI group at T2 only, and IL-6 levels were significantly higher in the AKI group at T2 and T3. Procalcitonin and myoglobin levels were significantly higher in the AKI group at T1, T2, and T3, when compared to the non-AKI group. Positive correlations were found between plasma NGAL and all screened physiological factors at all defined time points.
CONCLUSION
Development of AKI after blunt trauma is very complex and multifactorial. Activation of the systemic inflammatory response and rhabdomyolysis (high concentration of myoglobin) were strongly involved in AKI development. Blood NGAL levels after injury were significantly higher in patients, who developed posttraumatic AKI. Plasma NGAL, lactate, procalcitonin, interleukin-6, and myoglobin had potential to be useful parameters for risk stratification and prediction of AKI after trauma (Tab. 6, Ref. 40).
影响因子：
2.2
作者：
Apple, Camille G.;Miller, Elizabeth S.;Mohr, Alicia M.
通讯作者：
Mohr, Alicia M.