Urinary calprotectin, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin for the prediction of adverse outcome in pediatric acute kidney injury
Urinary calprotectin, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin for the prediction of adverse outcome in pediatric acute kidney injury
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DOI：
10.1007/s00431-017-2907-y
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发表时间：
2017-06-01
影响因子：
3.6
通讯作者：
Westhoff, Timm H.
中科院分区：
文献类型：
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作者：
Westhoff, Jens H.;Seibert, Felix S.;Westhoff, Timm H.
早期识别出具有不良后果高风险的急性肾损伤 (AKI) 患者可能会影响医疗治疗。本研究比较了尿钙卫蛋白、肾损伤分子 1 (KIM-1) 和中性粒细胞明胶酶相关脂质运载蛋白 (NGAL) 在预测儿科 AKI 患者死亡率和肾脏替代治疗 (RRT) 需求方面的表现。对 141 名 0-18 岁受试者的尿液生物标志物浓度进行了前瞻性评估，其中包括 55 名根据儿科风险、损伤、衰竭、丢失和终末期肾病 (pRIFLE) 标准确诊为 AKI 的患者、27 名没有 AKI 的患者和 59 名健康儿童。在 AKI 组中，受试者工作特征 (ROC) 曲线分析显示，钙卫蛋白和 KIM-1 在预测 30 天死亡率（钙卫蛋白曲线下面积 (AUC) 0.55；KIM-1 AUC 0.55）和 3 个月死亡率（钙卫蛋白 AUC 0.61；KIM-1 AUC 0.60）方面表现中等到差，在预测 RRT 需求（钙卫蛋白 AUC）方面表现一般。 0.72；KIM-1 AUC 0.71)。尿液 NGAL 在预测 30 天 (AUC 0.79) 和 3 个月 (AUC 0.81) 死亡率方面表现出良好的性能，在预测 RRT (AUC 0.61) 方面表现中等。结论：虽然尿液钙卫蛋白和 KIM-1 可用于预测 RRT，但尿液 NGAL 在预测异质性 AKI 儿科患者的死亡率方面具有良好的诊断性能。
Early identification of patients with acute kidney injury (AKI) being at high risk for adverse outcome can influence medical treatment. This study compares urinary calprotectin, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) for their performance in predicting mortality and need for renal replacement therapy (RRT) in pediatric AKI patients. Urinary biomarker concentrations were assessed prospectively in 141 subjects aged 0-18 years including 55 patients with established AKI according to pediatric Risk, Injury, Failure, Loss, and End-stage kidney disease (pRIFLE) criteria, 27 patients without AKI, and 59 healthy children. Within the AKI group, receiver operating characteristic (ROC) curve analysis revealed moderate to poor performance of calprotectin and KIM-1 in the prediction of 30-day mortality (calprotectin area under the curve (AUC) 0.55; KIM-1 AUC 0.55) and 3-month mortality (calprotectin AUC 0.61; KIM-1 AUC 0.60) and fair performance in the prediction of RRT requirement (calprotectin AUC 0.72; KIM-1 AUC 0.71). Urinary NGAL showed good performance in predicting 30-day (AUC 0.79) and 3-month (AUC 0.81) mortality and moderate performance in predicting RRT (AUC 0.61).Conclusions: Whereas urinary calprotectin and KIM-1 can be useful for the prediction of RRT, urinary NGAL has a good diagnostic performance in predicting mortality in pediatric patients with AKI of heterogeneous etiology.