Platelet Factor 4 Antibodies and Severe AKI.
Platelet Factor 4 Antibodies and Severe AKI.
复制标题
DOI：
10.34067/kid.0000000000000287
复制
发表时间：
2023-12-01
期刊：
影响因子：
--
通讯作者：
Leaf DE
中科院分区：
文献类型：
--
作者：
Thomas C;Ali R;Park I;Kim H;Short S;Kaunfer S;Durai L;Yilmam OA;Shenoy T;Battinelli EM;Al-Samkari H;Leaf DE
血小板因子4抗体检测呈阳性的患者发生严重AKI的几率比检测呈阴性的患者高50%。血小板因子4抗体与严重AKI之间的关系独立于人口统计学、合并症、实验室值和疾病严重程度特征。肝素诱导的血小板减少症是由于产生与肝素-血小板因子4 （PF4）复合物结合的抗体而引起的，是一种高凝状态，与血栓并发症引起的相当高的发病率和死亡率相关。我们研究了PF4抗体是否与AKI风险增加相关。我们对2015年至2021年间在波士顿两家大型医疗中心接受PF4抗体检测的住院成年人进行了一项队列研究。初次暴露为PF4试验阳性。主要结局是严重AKI，肾脏疾病：改善总体结局3期定义为PF4试验后7天内血清肌酐升高≥3倍或接受KRT。我们使用多变量逻辑回归来调整潜在的混杂因素。我们的分析共纳入4224例患者，其中469例（11.1%）患者PF4检测呈阳性。469例PF4检测阳性的患者中有50例（10.7%）发生严重AKI， 3755例PF4检测阴性的患者中有235例（6.3%）发生严重AKI（未经调整的优势比为1.79[95%可信区间为1.30 ~ 2.47]）。在对人口统计学、合并症、实验室值和疾病严重程度特征进行校正的多变量分析中，PF4检测阳性仍然与严重AKI的高风险相关（校正优势比为1.56[95%置信区间为1.10至2.20]）。在住院的成年人中，PF4抗体的存在与发生严重AKI的几率增加56%独立相关。需要进一步的研究来调查可能支持这些发现的潜在机制，例如PF4抗体对肾脏微血管的致病作用。
Patients testing positive for platelet factor 4 antibodies have a >50% higher odds of developing severe AKI compared with those who test negative. The relationship between platelet factor 4 antibodies and severe AKI was independent of demographics, comorbidities, laboratory values, and severity-of-illness characteristics. Heparin-induced thrombocytopenia, which results from production of antibodies that bind to heparin-platelet factor 4 (PF4) complexes, is a hypercoagulable state associated with considerable morbidity and mortality due to thrombotic complications. We investigated whether PF4 antibodies are associated with an increased risk of AKI. We conducted a cohort study of hospitalized adults who underwent testing for PF4 antibodies at two large medical centers in Boston between 2015 and 2021. The primary exposure was PF4 test positivity. The primary outcome was severe AKI, defined by Kidney Disease: Improving Global Outcomes stage 3 as a ≥3-fold increase in serum creatinine or receipt of KRT within 7 days after the PF4 test. We used multivariable logistic regression to adjust for potential confounders. A total of 4224 patients were included in our analysis, 469 (11.1%) of whom had a positive PF4 test. Severe AKI occurred in 50 of 469 patients (10.7%) with a positive PF4 test and in 235 of 3755 patients (6.3%) with a negative test (unadjusted odds ratio, 1.79 [95% confidence interval, 1.30 to 2.47]). In multivariable analyses adjusted for demographics, comorbidities, laboratory values, and severity-of-illness characteristics, PF4 test positivity remained associated with a higher risk of severe AKI (adjusted odds ratio, 1.56 [95% confidence interval, 1.10 to 2.20]). Among hospitalized adults, the presence of PF4 antibodies is independently associated with a 56% higher odds of developing severe AKI. Additional studies are needed to investigate potential mechanisms that may underlie these findings, such as pathogenic effects of PF4 antibodies on the microvasculature of the kidneys.
DOI：
10.1016/j.rpth.2023.102167
发表时间：
2023-08
影响因子：
4.6
作者：
Smilowitz, Nathaniel R.;Hade, Erinn M.;Kornblith, Lucy Z.;Castellucci, Lana A.;Cushman, Mary;Farkouh, Michael;Gong, Michelle N.;Heath, Anna;Hunt, Beverly J.;Kim, Keri S.;Kindzelski, Andrei;Lawler, Patrick;Leaf, David E.;Goligher, Ewan;Leifer, Eric S.;McVerry, Bryan J.;Reynolds, Harmony R.;Zarychanski, Ryan;Hochman, Judith S.;Neal, Matthew D.;Berger, Jeffrey S.
通讯作者：
Berger, Jeffrey S.