Angiopoietin-2 as a predictor of acute kidney injury in critically ill patients and association with ARDS
Angiopoietin-2 as a predictor of acute kidney injury in critically ill patients and association with ARDS
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DOI：
10.1111/resp.13464
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发表时间：
2019-04-01
期刊：
影响因子：
6.9
通讯作者：
Liborio, Alexandre Braga
中科院分区：
文献类型：
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作者：
Araujo, Camila Barbosa;de Oliveira Neves, Fernanda Macedo;Liborio, Alexandre Braga
背景和目的 血管生成素-2 (AGPT2) 被认为是器官功能障碍的关键介质，主要是在急性呼吸窘迫综合征 (ARDS) 中。它还与急性肾损伤（AKI）有关。我们的目的是研究 AGPT2 在患有和不患有 ARDS 的患者中的作用。方法 在一项危重患者队列研究中，对入住重症监护病房 (ICU) 后 24 小时内收集的血浆进行 AGPT1 和 AGPT2 检测。严重 AKI 和透析需求是通过比较分析得出的结果指标，其临床特征可用于 AKI 风险分层。结果 283 名患者（50.2% 为男性）中，109 名（38.5%）患有 ARDS。 ARDS 患者入院时 AGPT2 水平较高。尽管总体 AGPT2 和 AGPT2/AGPT1 水平与严重 AKI 相关，但这种关联在无 ARDS 的患者中并不显着；然而，它在 ARDS 患者中仍然非常重要。在没有 ARDS 的患者中，AGPT2 仅表现出较弱的预测严重 AKI 的辨别能力（曲线下面积 (AUC)：ARDS 组为 0.64 对比 0.81）。 AGPT2 纳入导致 ARDS 组的连续净重分类改善 (NRI) 为 64.1% (P < 0.001)，综合辨别改善 (IDI) 指数为 0.057 (P = 0.003)。无 ARDS 组的 NRI 没有显着差异。结论 AGPT2 和 AGPT2/AGPT1 比值与严重 AKI 相关，只有患有 ARDS 或有 ARDS 风险的患者需要肾脏替代治疗（RRT），其他危重患者不需要。将 AGPT2 添加到临床模型中可以显着提高预测 ARDS 患者严重 AKI 的能力。
Background and objective Angiopoietin-2 (AGPT2) has been proposed as a key mediator of organ dysfunction, mainly in acute respiratory distress syndrome (ARDS). It has also been associated with acute kidney injury (AKI). We aimed to investigate the role of AGPT2 in patients with and without ARDS. Methods In a cohort study with critically ill patients, AGPT1 and AGPT2 were assayed in plasma collected within the first 24 h after admission to intensive care unit (ICU). Severe AKI and the need for dialysis were outcome measures from comparative analysis with clinical characteristics useful for AKI risk stratification. Results Among 283 patients (50.2% males), 109 (38.5%) had ARDS. AGPT2 levels at admission were higher in patients with ARDS. Although overall AGPT2 and AGPT2/AGPT1 levels were associated with severe AKI, this association was not significant in patients without ARDS; however, it remained strongly significant in ARDS patients. In patients without ARDS, AGPT2 showed only a weak discriminatory capacity to predict severe AKI (area under the curve (AUC): 0.64 vs 0.81 in the ARDS group). The continuous net reclassification improvement (NRI) in the ARDS group resulting from AGPT2 inclusion was 64.1% (P < 0.001) and the integrated discrimination improvement (IDI) index was 0.057 (P = 0.003). There was no significant difference in NRI in the no-ARDS group. Conclusion AGPT2 and AGPT2/AGPT1 ratio are associated with severe AKI and there was only a need of renal replacement therapy (RRT) in patients with or at risk of ARDS, not in other critically ill patients. Adding AGPT2 to a clinical model resulted in a significant improvement in the capacity to predict severe AKI specifically in ARDS patients.