Quantitative and qualitative analyses of urinary L-FABP for predicting acute kidney injury after emergency laparotomy
Quantitative and qualitative analyses of urinary L-FABP for predicting acute kidney injury after emergency laparotomy
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DOI：
10.1007/s00540-021-03003-w
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发表时间：
2021-10-29
影响因子：
2.8
通讯作者：
Inoue, Soichiro
中科院分区：
文献类型：
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作者：
Okuda, Hirotaka;Obata, Yumi;Inoue, Soichiro
本研究的目的是探讨尿L-FABP在急诊剖腹手术后急性肾损伤（AKI）早期预测中的临床应用，并评估即时护理（POC）尿L-FABP检测试剂盒的临床应用。方法将48例急诊开腹手术患者按肾脏疾病改善总体预后（KDIGO）标准分为AKI组和非AKI组。AKI组10例。围手术期测定尿L-FABP、白蛋白、n -乙酰- β -d-氨基葡萄糖苷酶（NAG）、TIMP-2、IGFBP7、血清肌酐（SCr）、血压素，并进行组间比较。围手术期尿L-FABP也用POC试剂盒进行定性评估。结果AKI组L-FABP和白蛋白水平在各测点均显著升高。在AKI组中，NAG仅在术后显著升高。各测点[TIMP-2] x [IGFBP7]组间无差异。尿L-FABP受试者工作特征曲线下面积围手术期大于0.8，在整个研究期间均大于其他生物标志物。进入手术室后2 h尿L-FABP定量检测与定性检测的相关系数为0.714，最大。入组后2 h尿L-FABP POC试剂盒的敏感性、特异性和阴性预测值分别为55.6%、91.9%和89.5%。结论定量L-FABP分析可较早地预测急诊剖腹手术围手术期AKI的发生。相反，定性L-FABP分析的更高特异性表明，它可能有助于排除AKI的风险，但其整体临床有效性有待进一步研究。
Purpose The aim of this study was to explore the clinical utility of urinary L-FABP for earlier prediction of acute kidney injury (AKI) after emergency laparotomy, and to assess the clinical utility of a point-of-care (POC) kit for urinary L-FABP. Methods Forty-eight patients undergoing emergency laparotomy were divided into AKI and non-AKI groups by the kidney diseases: improving global outcome (KDIGO) criteria. Ten patients were included in the AKI group. Urinary L-FABP, albumin, N-acetyl-beta-d-glucosaminidase (NAG), TIMP-2, IGFBP7, serum creatinine (SCr), and blood presepsin were measured perioperatively and compared between groups. Perioperative urinary L-FABP was also evaluated qualitatively using a POC kit. Results L-FABP and albumin levels were significantly higher in the AKI group at all measurement points. NAG was significantly higher only postoperatively in the AKI group. There were no inter-group differences in [TIMP-2] x [IGFBP7] at any measuring point. The area under the receiver operating characteristic curve of urinary L-FABP was greater than 0.8 perioperatively, which was larger than that of other biomarkers throughout the study period. The correlation coefficient at 2 h after entering the operating room between quantitative and qualitative tests for urinary L-FABP was 0.714, which was the maximum. The sensitivity, specificity, and negative predictive value of the urinary L-FABP POC kit at 2 h after entry were 55.6%, 91.9%, and 89.5%, respectively. Conclusion Quantitative L-FABP analyses is suitable for predicting postoperative AKI earlier in the perioperative period of emergency laparotomy. Conversely, the higher specificity of qualitative L-FABP analysis suggests that it may be useful for excluding the risk of AKI but its overall clinical validity should be further investigated.