Microalbuminuria: A novel biomarker of sepsis.
Microalbuminuria: A novel biomarker of sepsis.
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DOI：
10.4103/0972-5229.63034
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Majumdar A
中科院分区：
文献类型：
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作者：
Basu S;Bhattacharya M;Chatterjee TK;Chaudhuri S;Todi SK;Majumdar A
脓毒症中弥漫性内皮功能障碍导致全身毛细血管通透性增加，肾脏成分表现为微量白蛋白尿。微量白蛋白尿的程度与急性损伤的严重程度相关，其定量可用于预测危重患者的脓毒症和死亡率。评估微量白蛋白尿的程度是否可以区分脓毒症患者和非脓毒症患者，并预测危重患者的死亡率。一项在三级护理医院的20床重症监护室（ICU）中进行的前瞻性、非干预性研究。在排除后，2007年1月至5月期间，发现94名连续的成年患者符合条件。在ICU入院时（ACR 1）和24小时（ACR 2）采集的尿液样本中测量白蛋白-肌酐比值（ACR，mg/g）。将患者分为两组：脓毒症、严重脓毒症和脓毒性休克患者（n = 30）和无脓毒症患者[无全身炎症反应综合征（SIRS）和非感染性原因导致的SIRS患者]（n = 64）。在脓毒症组中，中位ACR 1 [206.5（IQR129.7-506.1）]显著高于非脓毒症组[76.4（IQR 29 -167.1）]（P = 0.0016，Mann Whitney）。受试者工作特征（ROC）曲线分析显示，在124 mg/g的临界值，ACR 1可能能够区分有和无脓毒症患者的敏感性为80%，特异性为64.1%，阳性预测值（PPV）为51.1%，阴性预测值（NPV）为87.3%。与存活者[50.8（IQR 21.6-144.7）]相比，非存活者（n = 13）的中位ACR 2 [154（IQR 114.4 -395.3）]显著更高（P = 0.004）。ROC曲线分析显示，ACR 2在99.6 mg/g的临界值可以预测ICU死亡率，其敏感性为85%，特异性为68%，NPV为97%，PPV为30%。ICU入院时无明显微量白蛋白尿不太可能与脓毒症相关。在24小时，微量白蛋白尿水平不升高是ICU生存的强有力预测，相当于经过时间检验的APACHE II评分。
Diffused endothelial dysfunction in sepsis leads to an increase in systemic capillary permeability, the renal component manifesting as microalbuminuria. The degree of microalbuminuria correlates with the severity of the acute insult, the quantification of which may serve to predict sepsis and mortality in critically ill patients. To evaluate whether the degree of microalbuminuria could differentiate patients with sepsis from those without and predict mortality in critically ill patients. Prospective, non-interventional study in a 20-bed Intensive Care Unit (ICU) of a tertiary care hospital. After exclusions, between Jan-May 2007, 94 consecutive adult patients were found eligible. Albumin-creatinine ratio (ACR, mg/g) was measured in urine samples collected on ICU admission (ACR1) and at 24 hours (ACR2). Patients were classified into two groups: those with sepsis, severe sepsis and septic shock (n = 30) and those without sepsis [patients without systemic inflammatory response syndrome (SIRS) and with SIRS due to noninfectious causes] (n = 64). In the sepsis group, median ACR1 [206.5 (IQR129.7-506.1)] was significantly higher compared to the non sepsis group [76.4 (IQR29-167.1)] (P = 0.0016, Mann Whitney). The receiver operating characteristics (ROC) curve analysis showed that at a cut off value 124 mg/g, ACR1 may be able to discriminate between patients with and without sepsis with a sensitivity of 80%, specificity of 64.1%, positive predictive value (PPV) of 51.1% and negative predictive value (NPV) of 87.3%. The median ACR2 [154 (IQR114.4-395.3)] was significantly higher (P = 0.004) in nonsurvivors (n = 13) as compared to survivors [50.8 (IQR 21.6-144.7)]. The ROC curve analysis revealed that ACR2 at a cut-off of 99.6 mg/g could predict ICU mortality with sensitivity of 85%, specificity of 68% with a NPV of 97% and PPV of 30%. Absence of significant microalbuminuria on ICU admission is unlikely to be associated with sepsis. At 24 hours, absence of elevated levels of microalbuminuria is strongly predictive of ICU survival, equivalent to the time-tested APACHE II scores.