The Combination of SOFA Score and Urinary NGAL May Be an Effective Predictor for Ventilator Dependence among Critically Ill Surgical Patients: A Pilot Study.
The Combination of SOFA Score and Urinary NGAL May Be an Effective Predictor for Ventilator Dependence among Critically Ill Surgical Patients: A Pilot Study.
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SOFA 评分和尿液 NGAL 的结合可能是危重手术患者呼吸机依赖的有效预测因子：一项试点研究。
DOI：
10.3390/diagnostics11071186
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发表时间：
2021-06-30
期刊：
影响因子：
--
通讯作者：
Lee CW
中科院分区：
文献类型：
--
作者：
Tsai HI;Lu YC;Kou HW;Hsu HY;Huang SF;Huang CW;Lee CW
背景：呼吸机依赖（VD）已被认为是重症监护病房（ICU）危重患者的严重并发症。急性肾损伤（阿基）与VD相关，是肺-肾相互作用的结果。本研究的目的是探讨新的生物标志物在预测呼吸机依赖的危重手术患者。方法：收集外科ICU住院患者的血清和尿液样本。分析了新的生物标志物，包括明胶酶相关脂质运载蛋白（NGAL）、钙卫蛋白、肾损伤分子-1（KIM-1）、半胱氨酸蛋白酶抑制剂C和生长分化因子15（GDF-15），并将其与临床结局相关联。结果：共纳入33例患者并进行分析。他们中的大多数人在入住ICU之前接受了腹部手术。13例患者被归类为VD组，其余20例患者被归类为非呼吸机依赖组（nVD）。统计分析表明，VD组中以下各项显著高于nVD组：血清NGAL（420.25 ± 45.18 ng/mL vs. 314.68 ± 38.12 ng/mL，p值0.036），尿NGAL（420.87 ± 41.08 ng/mL vs. 250.84 ± 39.45 ng/mL，p值0.002），SOFA评分（11.3 ± 1.5 vs. 5.6 ± 0.7，p值0.001）和APACHE II评分（23.2 ± 2.6 vs. 13.6 ± 0.8，p值0.001）。VD尿NGAL的ROC曲线下面积（AUROC）为0.808。尿NGAL和SOFA评分的组合可进一步将VD的AUROC增加至0.835。结论：本研究证实了尿NGAL对外科危重患者呼吸机依赖的预测能力。结合SOFA评分，预测能力进一步增强。需要进一步的大规模研究来验证我们的发现。
Background: Ventilator dependence (VD) has been considered as a serious complication in critically ill patients in the intensive care unit (ICU). Acute kidney injury (AKI) is associated with VD as a result of lung–kidney interaction. The aim of our study was to investigate novel biomarkers in predicting ventilator dependence in critically ill surgical patients. Methods: Patients who were admitted to surgical ICU were enrolled and their serum and urine samples were collected. Novel biomarkers including gelatinase-associated lipocalin (NGAL), calprotectin, kidney injury molecule-1 (KIM-1), cystatin C, and growth differentiation factor 15 (GDF-15) were analyzed and correlated with clinical outcome. Results: A total of 33 patients were enrolled and analyzed. The majority of them received abdominal surgery prior to ICU admission. Thirteen patients were classified into the VD group, while the remaining 20 were in a non-ventilator dependence group (nVD). Statistical analysis demonstrated that the following were significantly higher in the VD group than in the nVD group: serum NGAL (420.25 ± 45.18 ng/mL vs. 314.68 ± 38.12 ng/mL, p-value 0.036), urinary NGAL (420.87 ± 41.08 ng/mL vs. 250.84 ± 39.45 ng/mL, p-value 0.002), SOFA score (11.3 ± 1.5 vs. 5.6 ± 0.7, p-value 0.001), and APACHE II score (23.2 ± 2.6 vs. 13.6 ± 0.8, p-value 0.001). The area under the ROC curve (AUROC) of urinary NGAL for VD was 0.808. The combination of urinary NGAL and SOFA score could further increase AUROC for VD to 0.835. Conclusions: The current study demonstrated the predictive capability of urinary NGAL for ventilator dependence among critically ill surgical patients. When combined with SOFA score, the predictive ability was further augmented. Further large-scale studies are warranted to validate our findings.
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