Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery
Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery
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DOI：
10.1016/j.jtcvs.2017.12.056
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发表时间：
2018-06-01
影响因子：
6
通讯作者：
Haase-Fielitz, Anja
中科院分区：
文献类型：
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作者：
Albert, Christian;Albert, Annemarie;Haase-Fielitz, Anja
目的：本研究的目的是确定生物标志物的具体结果模式和短期和长期预后的心脏手术相关的急性肾损伤（阿基）确定的标准标准和/或尿肾biologicals.Methods：患者入组（N = 200），起源于德国的多中心研究（NCT 00672334）。标准风险损伤、衰竭、丢失和终末期肾病分类（步枪）标准（包括血清肌酐和尿量）和尿肾脏生物标志物检测结果（中性粒细胞明胶酶相关脂质运载蛋白、中期因子、白细胞介素6和蛋白尿）用于诊断术后阿基。主要终点为急性肾脏替代治疗或住院死亡率。长期终点包括5年死亡率。确定了单一生物标志物阳性亚临床阿基（步枪阴性）患者。我们控制全身炎症使用C-反应蛋白test.Results：尿生物标志物（中性粒细胞明胶酶相关脂质运载蛋白，中期因子，白细胞介素6）被确定为主要终点的独立预测因子。中性粒细胞明胶酶相关脂质运载蛋白、中期因子或白细胞介素6阳性或新发/恶化的蛋白尿分别增加了21.1%、16.9%、30.5%和48.0%，除了单独步枪阳性的病例外，还可能出现亚临床阿基（生物标志物阳性/步枪阴性）。有可能亚临床阿基（中性粒细胞明胶酶相关脂质运载蛋白或白细胞介素6阳性）的患者发生主要终点的风险增加（调整后的风险比，7.18; 95%置信区间，1.52-33.93 [P = .013]和风险比，6.27; 95%置信区间，1.12-35.21 [P = .037]）。与生物标志物阴性/RIFLE阳性患者相比，中性粒细胞明胶酶相关脂质运载蛋白阳性/RIFLE阳性或中期因子阳性/RIFLE阳性患者的主要终点风险增加（比值比，9.6; 95%置信区间，1.4-67.3 [P = .033]和比值比，14.7; 95%置信区间，2.0-109.2 [P = .011]）。3%至11%的患者似乎受到单一生物标志物阳性亚临床阿基的影响。在随访期间，肾脏生物标志物定义的短期结果似乎转化为长期outcome.Conclusions尿肾脏生物标志物确定RIFLE阴性患者高风险亚临床阿基以及RIFLE-AKI阳性患者中的高风险亚组患者。这些发现支持了尿生物标志物定义亚临床阿基和标准阿基患者中长期预后较差的高风险亚群的概念。
Objective: This study aimed to determine the biomarker-specific outcome patterns and short-and long-term prognosis of cardiac surgery-asoociated acute kidney injury (AKI) identified by standard criteria and/or urinary kidney biomarkers.Methods: Patients enrolled (N = 200), originated a German multicenter study (NCT00672334). Standard risk injury, failure, loss, and end-stage renal disease classification (RIFLE) criteria (including serum creatinine and urine output) and urinary kidney biomarker test result (neutrophil gelatinase-associated lipocalin, midkine, interleukin 6, and proteinuria) were used for diagnosis of postoperative AKI. Primary end point was acute renal replacement therapy or in-hospital mortality. Long-term end points among others included 5-year mortality. Patients with single-biomarker-positive subclinical AKI (RIFLE negative) were identified. We controlled for systemic inflammation using C-reactive protein test.Results: Urinary biomarkers (neutrophil gelatinase-associated lipocalin, midkine, and interleukin 6) were identified as independent predictors of the primary end point. Neutrophil gelatinase-associated lipocalin, midkine, or interleukin 6 positivity or de novo/worsening proteinuria identified 21.1%, 16.9%, 30.5%, and 48.0% more cases, respectively, with likely subclinical AKI (biomarker positive/RIFLE negative) additionally to cases with RIFLE positivity alone. Patients with likely subclinical AKI (neutrophil gelatinase-associated lipocalin or interleukin 6 positive) had increased risk of primary end point (adjusted hazard ratio, 7.18; 95% confidence interval, 1.52-33.93 [P = .013] and hazard ratio, 6.27; 95% confidence interval, 1.12-35.21 [P = .037]), respectively. Compared with biomarker-negative/RIFLE-positive patients, neutrophil gelatinase-associated lipocalin positive/RIFLE-positive or midkine-positive/ RIFLE-positive patients had increased risk of primary end point (odds ratio, 9.6; 95% confidence interval, 1.4-67.3 [P = .033] and odds ratio, 14.7; 95% confidence interval, 2.0-109.2 [P = .011], respectively). Three percent to 11% of patients appear to be influenced by single-biomarker-positive subclinical AKI. During follow-up, kidney biomarker-defined short-term outcomes appeared to translate into long-term outcomes.Conclusions Urinary kidney biomarkers identified RIFLE-negative patients with high-risk subclinical AKI as well as a higher risk subgroup of patients among RIFLE-AKI positive patients. These findings support the concept that urinary biomarkers define subclinical AKI and higher risk subpopulations with worse long-term prognosis among standard patients with AKI.