Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery.
Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery.
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功能性和管状损伤生物标志物可提高心脏手术后急性肾脏损伤的诊断精度。
DOI：
10.1016/j.jacc.2014.09.066
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发表时间：
2014-12-30
影响因子：
24
通讯作者：
Goldstein, Stuart L.
中科院分区：
文献类型：
--
作者：
Basu, Rajit K.;Wong, Hector R.;Krawczeski, Catherine D.;Wheeler, Derek S.;Manning, Peter B.;Chawla, Lakhmir S.;Devarajan, Prasad;Goldstein, Stuart L.
关键词：
血清肌酐（ΔSCr）较基线升高表示急性肾损伤（阿基），但几乎没有提供关于其特征的颗粒信息。第10届急性透析质量倡议（ADQI）共识会议建议，结合阿基生物标志物将为阿基病程预测提供更好的精确度。本研究调查了功能性损伤生物标志物（血浆胱抑素C [pCysC]）与肾小管损伤生物标志物（尿中性粒细胞明胶酶相关脂质运载蛋白[uNGAL]）相结合的价值，形成了预测阿基离散特征的复合生物标志物。本文分析了345例小儿体外循环（CPB）术后的资料。重度阿基定义为体外循环7天内肾脏疾病全球结局倡议2至3级（>100% ΔSCr）。持续性阿基持续>2天。可逆性阿基的SCr在CPB后≤48 h恢复至基线。uNGAL（>200 ng/mg尿Cr =阳性[+]）和pCysC（>0.8 mg/l =阳性[+]）的复合物uNGAL+/pCysC+（在CPB开始后2小时测量）与≤50%的ΔSCr增加进行比较，通过使用预测概率、似然比（LR）和曲线下面积接收器操作曲线（AUC-ROC）值来确定与阿基特征的相关性。18%的患者发生重度阿基。复合uNGAL+/pCysC+显示重度阿基（+LR：34.2 [13.0：94.0] vs. 3.8 [1.9：7.2]）和持续性阿基（+LR：15.6 [8.8：27.5] vs. 4.5 [2.3：8.8]）的可能性大于ΔSCr。在阿基患者中，uNGAL−/pCysC+复合物在预测一过性阿基方面上级优于ΔSCr。生物标志物复合物比ΔSCr分层具有更高的特定结局概率。在预测阿基的离散特征方面，功能性和肾小管损伤生物标志物的复合物优于ΔSCr的上级。
Increases in serum creatinine (ΔSCr) from baseline signify acute kidney injury (AKI) but offer little granular information regarding its characteristics. The 10th Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) suggested that combining AKI biomarkers would provide better precision for AKI course prognostication. This study investigated the value of combining a functional damage biomarker (plasma cystatin C [pCysC]) with a tubular damage biomarker (urine neutrophil gelatinase-associated lipocalin [uNGAL]), forming a composite biomarker for prediction of discrete characteristics of AKI. Data from 345 children after cardiopulmonary bypass (CPB) were analyzed. Severe AKI was defined as Kidney Disease Global Outcomes Initiative stages 2 to 3 (>100% ΔSCr) within 7 days of CPB. Persistent AKI lasted >2 days. SCr in reversible AKI returned to baseline ≤48 h after CPB. The composite of uNGAL (>200 ng/mg urine Cr = positive [+]) and pCysC (>0.8 mg/l = positive [+]), uNGAL+/pCysC+, measured 2 h after CPB initiation, was compared to ΔSCr increases of ≤50% for correlation with AKI characteristics by using predictive probabilities, likelihood ratios (LR), and area under the curve receiver operating curve (AUC-ROC) values. Severe AKI occurred in 18% of patients. The composite uNGAL+/pCysC+ demonstrated a greater likelihood than ΔSCr for severe AKI (+LR: 34.2 [13.0:94.0] vs. 3.8 [1.9:7.2]) and persistent AKI (+LR: 15.6 [8.8:27.5] versus 4.5 [2.3:8.8]). In AKI patients, the uNGAL−/pCysC+ composite was superior to ΔSCr for prediction of transient AKI. Biomarker composites carried greater probability for specific outcomes than ΔSCr strata. Composites of functional and tubular damage biomarkers are superior to ΔSCr for predicting discrete characteristics of AKI.
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DOI：
10.4103/1319-2442.132194
发表时间：
2014-05-01
影响因子：
0.5
作者：
Ghonemy, Tarek A.;Amro, Ghada M.
通讯作者：
Amro, Ghada M.
DOI：
10.2215/cjn.04010907
发表时间：
2008-05-01
影响因子：
9.8
作者：
Bennett, Michael;Dent, Catherine L.;Devarajan, Prasad
通讯作者：
Devarajan, Prasad
DOI：
10.1159/000349964
发表时间：
2013-01-01
期刊：
ADQI CONSENSUS ON AKI BIOMARKERS AND CARDIORENAL SYNDROMES
影响因子：
--
作者：
Endre, Zoltan H.;Kellum, John A.;Murray, Patrick T.
通讯作者：
Murray, Patrick T.
影响因子：
--
作者：
McCullough PA;Bouchard J;Waikar SS;Siew ED;Endre ZH;Goldstein SL;Koyner JL;Macedo E;Doi K;Di Somma S;Lewington A;Thadhani R;Chakravarthi R;Ice C;Okusa MD;Duranteau J;Doran P;Yang L;Jaber BL;Meehan S;Kellum JA;Haase M;Murray PT;Cruz D;Maisel A;Bagshaw SM;Chawla LS;Mehta RL;Shaw AD;Ronco C
通讯作者：
Ronco C
影响因子：
6
作者：
Jenkins, KJ;Gauvreau, K;Iezzoni, LI
通讯作者：
Iezzoni, LI