Undetectable haptoglobin is associated with major adverse kidney events in critically ill burn patients
Undetectable haptoglobin is associated with major adverse kidney events in critically ill burn patients
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DOI：
10.1186/s13054-017-1837-4
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发表时间：
2017-09-26
期刊：
影响因子：
15.1
通讯作者：
Legrand, Matthieu
中科院分区：
文献类型：
--
作者：
Depret, Francois;Dunyach, Chloe;Legrand, Matthieu
背景：在不同的临床环境（心脏手术、镰状细胞病）中，血管内溶血与急性肾损伤（AKI）有关。危重烧伤患者经常发生溶血。本研究的目的是评估入院时触珠蛋白对危重烧伤患者主要不良肾脏事件 (MAKE) 和 AKI 的预测价值。方法：我们在三级中心的烧伤重症监护病房进行了一项回顾性、单中心队列研究，包括 2012 年 1 月至 2017 年 4 月期间所有连续严重烧伤患者（总烧伤体表面积 > 20% 和/或入院时休克和/或机械通气），使用血浆入院时触珠蛋白剂量。结果：共有 130 名患者纳入分析。他们的平均年龄为 49 (34-62) 岁，全身烧伤面积中位数为 29% (15-51%)，重症监护病房 (ICU) 死亡率为 25%。早期溶血被定义为入院时血浆触珠蛋白检测不到。我们使用逻辑回归来识别 MAKE 和 AKI 风险因素。在多变量分析中，未检测到的触珠蛋白与 MAKE 和 AKI 相关（分别为 OR 6.33，95% CI 2.34-16.45，p < 0.001；OR 8.32，95% CI 2.86-26.40，p < 0.001）。结论：入 ICU 时血浆触珠蛋白未检测到是一个独立危险因素用于重症烧伤患者的 MAKE 和 AKI。这项研究为危重烧伤患者使用触珠蛋白进行生物标志物引导治疗提供了理论依据。
Background: Intravascular haemolysis has been associated with acute kidney injury (AKI) in different clinical settings (cardiac surgery, sickle cell disease). Haemolysis occurs frequently in critically ill burn patients. The aim of this study was to assess the predictive value of haptoglobin at admission to predict major adverse kidney events (MAKE) and AKI in critically ill burn patients.Methods: We conducted a retrospective, single-centre cohort study in a burn critical care unit in a tertiary centre, including all consecutive severely burned patients (total burned body surface > 20% and/or shock and/or mechanical ventilation at admission) from January 2012 to April 2017 with a plasmatic haptoglobin dosage at admission.Results: A total of 130 patients were included in the analysis. Their mean age was 49 (34-62) years, their median total body surface area burned was 29% (15-51%) and the intensive care unit (ICU) mortality was 25%. Early haemolysis was defined as an undetectable plasmatic haptoglobin at admission. We used logistic regression to identify MAKE and AKI risk factors. In multivariate analysis, undetectable haptoglobin was associated with MAKE and AKI (respectively, OR 6.33, 95% CI 2.34-16.45, p < 0.001; OR 8.32, 95% CI 2.86-26.40, p < 0.001).Conclusions: Undetectable plasmatic haptoglobin at ICU admission is an independent risk factor for MAKE and AKI in critically ill burn patients. This study provides a rationale for biomarker-guided therapy using haptoglobin in critically ill burn patients.