Neutrophil Gelatinase-Associated Lipocalin Concentrations Predict Development of Acute Kidney Injury in Neonates and Children after Cardiopulmonary Bypass
Neutrophil Gelatinase-Associated Lipocalin Concentrations Predict Development of Acute Kidney Injury in Neonates and Children after Cardiopulmonary Bypass
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DOI：
10.1016/j.jpeds.2010.12.057
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发表时间：
2011-06-01
影响因子：
5.1
通讯作者：
Devarajan, Prasad
中科院分区：
文献类型：
--
作者：
Krawczeski, Catherine D.;Woo, Jessica G.;Devarajan, Prasad
目的探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）作为新生儿和小儿体外循环（CPB）后早期急性肾损伤（阿基）的生物标志物。阿基定义为CPB后48小时内，新生儿血清肌酐（SCr）浓度较基线升高>= 0.3 mg/dL，儿童血清肌酐（SCr）浓度较基线升高>= 50%。Logistic回归分析用于评估与阿基相关的预测因素和临床结局。结果30%的患者发生阿基。阿基患者的血浆和尿液NGAL阈值在CPB后2小时显著升高，并在所有时间点保持升高，2小时NGAL是阿基最早、最强的预测因子。结论血浆和尿液NGAL阈值可作为CPB后阿基及其临床预后的早期预测指标。在新生儿中，我们建议诊断阿基的2小时血浆NGAL阈值为100 ng/mL，2小时尿液NGAL阈值为185 ng/mL。在非新生儿中，2小时血浆和尿液NGAL的推荐阿基阈值均为50 ng/mL。（J Pediatr 2011;158：1009-15）。
Objectives To investigate neutrophil gelatinase-associated lipocalin (NGAL) as an early acute kidney injury (AKI) biomarker after neonatal and pediatric cardiopulmonary bypass (CPB).Study design Serum and urine samples were obtained before and at intervals after CPB from 374 patients. AKI was defined as a serum creatinine (SCr) concentration increase from baseline >= 0.3 mg/dL in neonates and >= 50% in children within 48 hours of CPB. Logistic regression was used to assess predictors and clinical outcomes associated with AKI.Results AKI developed in 30% of patients. Plasma and urine NGAL thresholds significantly increased in patients with AKI at 2 hours after CPB and remained elevated at all points, with 2-hour NGAL the earliest, strongest predictor of AKI. In non-neonates, 2-hour plasma and urine NGAL thresholds strongly correlated with length of hospital stay and severity and duration of AKI.Conclusion Plasma and urine NGAL thresholds are early predictive biomarkers for AKI and its clinical outcomes after CPB. In neonates, we recommend a 2-hour plasma NGAL threshold of 100 ng/mL and 2-hour urine NGAL threshold of 185 ng/mL for diagnosis of AKI. In non-neonates, recommended AKI thresholds are 50 ng/mL for both 2-hour plasma and urine NGAL. (J Pediatr 2011;158:1009-15).