Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery-A prospective cohort study
Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery-A prospective cohort study
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DOI：
10.1097/ccm.0b013e318195846e
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发表时间：
2009-02-01
影响因子：
8.8
通讯作者：
Haase, Michael
中科院分区：
文献类型：
--
作者：
Haase-Fielitz, Anja;Bellomo, Rinaldo;Haase, Michael
目标。目的：比较新型血清生物标志物和常规血清生物标志物在成人心脏手术患者急性肾损伤(AKI)预测中的价值。设计：单中心前瞻性观察研究。地点：三级医院。患者：100例成人心脏手术患者。测量和主要结果。我们在基线、到达重症监护病房(ICU)时和术后24小时测定血浆中性粒细胞明胶酶相关脂蛋白(NGAL)、血清胱抑素C、肌酐和尿素的浓度。我们评估了这些生物标志物与AKI的发展(肌酐较基线增加50%)和复合终点(需要肾脏替代治疗和住院死亡率)的关系。根据预测价值，我们定义了接收器操作特征曲线下的区域0.60-0.69为差，0.70-0.79为可，0.80-0.89为好，0.90-1.00为优。到达ICU时，血浆NGAL和血清半胱氨酸氨基转移酶C有较好的预测价值，而肌酐和尿素的预测价值较差。排除术前肾损害患者后(估计肾小球滤过率
Objective. To compare the value of novel with conventional serum biomarkers in the prediction of acute kidney injury (AKI) in adult cardiac surgical patients according to preoperative renal function.Design: Single-center, prospective observational study.Setting: Tertiary hospital.Patients: One hundred adult cardiac surgical patients.Measurements and Main Results. We measured concentrations of plasma neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C, and creatinine and urea at baseline, on arrival in the intensive care unit (ICU) and at 24 hours postoperatively. We assessed such biomarkers in relation to the development of AKI (>50% increase in creatinine from baseline) and to a composite end point (need for renal replacement therapy and in-hospital mortality). We defined an area under the receiver operating characteristic curve of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. On arrival in ICU, plasma NGAL and serum cystatin C were of good predictive value, but creatinine and urea were of poor predictive value. After exclusion of patients with preoperative renal impairment (estimated glomerular filtration rate