Urinary neutrophil gelatinase-associated lipocalin was a predictor from the day after intensive care unit entry, but not on the day of intensive care unit entry
Urinary neutrophil gelatinase-associated lipocalin was a predictor from the day after intensive care unit entry, but not on the day of intensive care unit entry
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尿中性粒细胞明胶酶相关脂质运载蛋白是进入重症监护室后第二天的预测因子，但不是进入重症监护室当天的预测因子
DOI：
10.1016/j.cca.2021.02.017
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发表时间：
2021
影响因子：
5
通讯作者：
Minami Toshiaki
中科院分区：
文献类型：
--
作者：
Shimoyama Yuichiro;Kadono Noriko;Umegaki Osamu;Minami Toshiaki
背景与目的败血症是感染致死的主要原因。本研究旨在确定中性粒细胞明胶酶相关脂钙蛋白（NGAL）值与基于炎症的预后评分是否能更好地预测败血症患者的死亡率。材料与方法对2018年6月至2018年11月入住ICU的44例符合脓毒症-3定义的成人患者进行前瞻性检查。采用尿道球囊法采集患者入ICU后尿液，分别于入ICU后即刻、入ICU后第2天、第3天和第4天测量NGAL水平。进入ICU后立即进行格拉斯哥预后评分、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、预后营养指数、预后指数（PI）、顺序器官衰竭评估（SOFA）和快速SOFA。采用受试者工作特征曲线（ROC）分析、log-rank检验和多因素logistic回归分析评估死亡率预测因子。结果28天死亡率为第4天的sngal （AUC: 0.94）和第4 ~ 1天的ΔNGAL (AUC: 0.9)；第4天NGAL （AUC: 0.94）和炎症-NGAL评分（iNS） NGAL- pi （AUC: 0.69）计算60天死亡率；第3天至第1天的90天死亡率为ΔNGAL (AUC: 0.82)；通过ROC曲线分析发现住院死亡率的iNS NGAL-NLR （AUC: 0.71）和iNS NGAL-PI （AUC: 0.68）是死亡率的预测因子。28天死亡率NLR (p = 0.02)；第2天NGAL (p = 0.031)，第2天至第1天ΔNGAL (p = 0.013)， 60天死亡率NLR (p < 0.0001)；第2天NGAL (p = 0.017)，第2天至第1天ΔNGAL (p = 0.014)， 90天死亡率NLR (p = 0.033)；经log-rank检验发现住院死亡率第2天的NGAL （p = 0.007）是死亡率的预测因子。多因素logistic回归分析发现，60天死亡率的NGAL- nlr （OR, 0.024; p = 0.019）和90天死亡率的NGAL （OR, 1.005; p = 0.013）是死亡率的预测因子。结论sngal和ΔNGAL是脓毒症患者进入ICU后第2天及以后死亡率的预测因子，但不是第1天死亡率的预测因子。
Background and aimsSepsis is the main cause of death from infection. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) values better predict mortality in septic patients when combined with inflammation-based prognostic scores.Material and methodsForty-four adult patients diagnosed according to the Sepsis-3 definition and who were admitted to the ICU were prospectively examined from June 2018 to November 2018. Urine samples were collected from each patient with a urethral balloon bag to measure NGAL after ICU entry at the following time points: immediately after and 2, 3, and 4 days after ICU entry. The Glasgow Prognostic Score, the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio, the Prognostic Nutritional Index, the Prognostic Index (PI), the Sequential Organ Failure Assessment (SOFA), and quick SOFA were examined immediately after ICU entry. Predictors of mortality were assessed by receiver operating characteristics curve (ROC) analysis, log-rank test, and multivariate logistic regression analysis.ResultsNGAL on day 4 (AUC: 0.94) and ΔNGAL from day 4 to day 1 (AUC: 0.9) for 28-day mortality; NGAL on day 4 (AUC: 0.94) and inflammation-NGAL score (iNS) NGAL-PI (AUC: 0.69) for 60-day mortality; ΔNGAL from day 3 to day 1 (AUC: 0.82) for 90-day mortality; and iNS NGAL-NLR (AUC: 0.71) and iNS NGAL-PI (AUC: 0.68) for in-hospital mortality were found to be predictors of mortality by ROC curve analysis. NLR (p = 0.02) for 28-day mortality; NGAL on day 2 (p = 0.031), ΔNGAL from day 2 to day 1 (p = 0.013), and NLR (p < 0.0001) for 60-day mortality; NGAL on day 2 (p = 0.017), ΔNGAL from day 2 to day 1 (p = 0.014), and NLR (p = 0.033) for 90-day mortality; and NGAL on day 2 (p = 0.007) for in-hospital mortality were found to be predictors of mortality by log-rank test. iNS NGAL-NLR (OR, 0.024; p = 0.019) for 60-day mortality and NGAL from day 3 to day 1 (OR, 1.005; p = 0.013) for 90-day mortality were found to be predictors of mortality by multivariate logistic regression analysis.ConclusionsNGAL and ΔNGAL were predictors of mortality in sepsis patients on day 2 after ICU entry and thereafter, but not on day 1.