The diagnostic and prognostic values of serum and urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in sepsis induced acute renal injury patients.
The diagnostic and prognostic values of serum and urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in sepsis induced acute renal injury patients.
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DOI：
10.26355/eurrev_202005_21346
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发表时间：
2020-05
影响因子：
3.3
通讯作者：
C-F Zhang;H-J Wang;Z. Tong;Chunfeng Zhang;Y-S Wang;H. Yang;Rachel Y. Gao;H-Z Shi
中科院分区：
文献类型：
--
作者：
C-F Zhang;H-J Wang;Z. Tong;Chunfeng Zhang;Y-S Wang;H. Yang;Rachel Y. Gao;H-Z Shi
目的 肾损伤分子 1 (uKIM-1) 和中性粒细胞明胶酶相关脂质运载蛋白 (uNGAL、sNGAL) 已被证明是多种疾病中急性肾损伤 (AKI) 的诊断生物标志物。然而，这两种方法在脓毒症合并急性肾损伤的患者中都没有得到很好的验证。患者和方法 这是一项前瞻性观察性研究，在北京朝阳医院的三个重症监护病房进行。在 12 个月的时间里，共有 174 名患者（70 名脓毒症患者、69 名脓毒症合并 AKI 患者和 35 名对照者）入组。入院时尽快（24小时内）采集血液和尿液标本，并检测KIM-1和NGAL水平。结果 发生 AKI 的脓毒症患者中 uKIM-1、uNGAL、sNGAL 水平显着高于无 AKI 的脓毒症患者（0.88 ng/ml (0.37, 2.14) vs. 1.21 ng/ml (0.67, 3.26) p=0.003, 63.54 ng/ml (21.66,分别为 125.45) 与 249.85 ng/ml (86.60, 585.97) p<0.001，以及 108.08 ng/ml (67.74, 212.22) 与 200.01 ng/ml (102.76, 300.77) p=0.001。 sKIM-1 在两组之间也有显着差异（83.98 pg/ml (54.00,147.08) 与 193.41 pg/ml (106.90, 430.60) p<0.001）。四种生物标志物（uKIM-1、sKIM-1、uNGAL、sNGAL）均可预测 AKI，受试者工作特征曲线下面积（AUROC）分别为 0.607、0.754、0.768、0.658。 uNGAL 是脓毒性 AKI 的独立危险因素，AUROC 为 0.768（95% CI：0.689 至 0.835）。 uNGAL和sNGAL与脓毒症的预后相关。结论 我们的结果表明 NGAL 是一种有前途的脓毒症 AKI 生物标志物。与uKIM-1一样，sKIM-1也可以早期预测脓毒症AKI的发生，但两者对于判断AKI的严重程度和脓毒症的预后均不具有预测价值。
OBJECTIVE The kidney injury molecule-1 (uKIM-1) and neutrophil gelatinase-associated lipocalin (uNGAL, sNGAL) have been demonstrated to be diagnostic biomarkers for acute kidney injury (AKI) in a variety of diseases. However, both of them were not well validated in sepsis patients with acute kidney injury. PATIENTS AND METHODS This was a prospective and observational study which was performed in the three intensive care units of the Beijing Chao-Yang Hospital. Over a 12-month period, 174 patients (70 sepsis patients, 69 sepsis with AKI and 35 controls) were enrolled. Blood and urinary specimens were collected at admission as soon as possible (within 24 hours) and KIM-1 and NGAL levels were tested. RESULTS Levels of uKIM-1, uNGAL, sNGAL were significantly higher in the sepsis patients who developed AKI compared to those sepsis with no-AKI (0.88 ng/ml (0.37, 2.14) vs. 1.21 ng/ml (0.67, 3.26) p=0.003, 63.54 ng/ml (21.66, 125.45) vs. 249.85 ng/ml (86.60, 585.97) p<0.001, and 108.08 ng/ml (67.74, 212.22) vs. 200.01 ng/ml (102.76, 300.77) p=0.001, respectively). sKIM-1 also had significant differences between the two groups (83.98 pg/ml (54.00,147.08) vs. 193.41 pg/ml (106.90, 430.60) p<0.001). The four biomarkers (uKIM-1, sKIM-1, uNGAL, sNGAL) all could be predictive for AKI, and the areas under the receiver operating characteristic curves (AUROC) were 0.607, 0.754, 0.768, 0.658, respectively. The uNGAL was an independent risk factor for septic AKI, and the AUROC was 0.768 (95% CI: 0.689 to 0.835). The uNGAL and sNGAL were related to the prognosis of sepsis. CONCLUSIONS Our results showed that NGAL was a promising biomarker of septic AKI. Like the uKIM-1, the sKIM-1 could early predict the occurrence of septic AKI too, but both of them did not have the predictive value in judging the severity of AKI and the prognosis of sepsis.