Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness
Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness
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DOI：
10.1007/s00134-009-1724-9
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发表时间：
2010-03-01
影响因子：
38.9
通讯作者：
Bellomo, Rinaldo
中科院分区：
文献类型：
--
作者：
Bagshaw, Sean M.;Bennett, Michael;Bellomo, Rinaldo
脓毒症是危重病患者急性肾损伤(AKI)最常见的诱因。我们试图确定败血症和非败血症AKI患者的血浆和尿中性粒细胞明胶酶相关脂蛋白(NGAL)是否有独特的模式。前瞻性观察研究：澳大利亚墨尔本的两个成人ICU，败血症和非败血症AKI危重患者。83例患者入选，其中败血症43例。败血症急性心肌梗死患者有更多的并存疾病(p=0.005)、急诊手术入院(p<；0.001)、更严重的疾病(p=0.008)、更多的器官功能障碍(p=0.008)和更高的白细胞计数(p=0.008)。在AKI严重性方面，不同组之间的登记情况没有差异。与非败血症急性心肌梗死相比，败血症急性心肌梗死患者在登记时血浆(293vs.166 ng/ml)和尿液(204vs.39 ng/mg肌酐)NGAL显著升高(p<；0.001)。脓毒症患者尿NGAL在12h(p<；0.001)和24 h(p<；0.001)仍高于非败血症患者(p<；0.001)。血浆NGAL对AKI进展(受试者-操作者特征曲线下面积0.71)和肾脏替代治疗(AuROC 0.78)有较好的鉴别作用。尽管尿NGAL表现不佳(AuROC 0.70，0.70)，但在非感染性AKI患者中，尿NGAL峰值对AKI进展的预测更好(AuROC 0.82)。与非感染性AKI患者相比，感染性AKI患者血浆和尿液NGAL的可检测率更高。败血症AKI患者NGAL值的这些差异可能具有诊断和临床意义以及发病机制。
Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. We sought to determine whether there are unique patterns to plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in septic compared with non-septic AKI.Prospective observational study.Two adult ICUs in Melbourne, Australia.Critically ill patients with septic and non-septic AKI.None.Blood and urine specimens collected at enrollment, 12, 24 and 48 h to measure plasma and urine NGAL. Eighty-three patients were enrolled (septic n = 43). Septic AKI patients had more co-morbid disease (p = 0.005), emergency surgical admissions (p < 0.001), higher illness severity (p = 0.008), more organ dysfunction (p = 0.008) and higher white blood cell counts (p = 0.01). There were no differences at enrollment between groups in AKI severity. Septic AKI was associated with significantly higher plasma (293 vs. 166 ng/ml) and urine (204 vs. 39 ng/mg creatinine) NGAL at enrollment compared with non-septic AKI (p < 0.001). Urine NGAL remained higher in septic compared with non-septic AKI at 12 h (p < 0.001) and 24 h (p < 0.001). Plasma NGAL showed fair discrimination for AKI progression (area under receiver-operator characteristic curve 0.71) and renal replacement therapy (AuROC 0.78). Although urine NGAL performed less well (AuROC 0.70, 0.70), peak urine NGAL predicted AKI progression better in non-septic AKI (AuROC 0.82).Septic AKI patients have higher detectable plasma and urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.