PDF(Pubmed)
Abstract：
The kidney injury molecule (KIM)-1 is shed from proximal tubular cells in acute kidney injury (AKI), relaying tubular epithelial proliferation. Additionally, KIM-1 portends complex immunoregulation and is elevated after exposure to lipopolysaccharides. It thus may represent a biomarker in critical illness, sepsis, and sepsis-associated AKI (SA-AKI). To characterise and compare KIM-1 in these settings, we analysed KIM-1 serum concentrations in 192 critically ill patients admitted to the intensive care unit. Irrespective of kidney dysfunction, KIM-1 serum levels were significantly higher in patients with sepsis compared with other critical illnesses (191.6 vs. 132.2 pg/mL, p = 0.019) and were highest in patients with urogenital sepsis, followed by liver failure. Furthermore, KIM-1 levels were significantly elevated in critically ill patients who developed AKI within 48 h (273.3 vs. 125.8 pg/mL, p = 0.026) or later received renal replacement therapy (RRT) (299.7 vs. 146.3 pg/mL, p < 0.001). KIM-1 correlated with markers of renal function, inflammatory parameters, hematopoietic function, and cholangiocellular injury. Among subcomponents of the SOFA score, KIM-1 was elevated in patients with hyperbilirubinaemia (>2 mg/dL, p < 0.001) and thrombocytopenia (<150/nL, p = 0.018). In univariate and multivariate regression analyses, KIM-1 predicted sepsis, the need for RRT, and multi-organ dysfunction (MOD, SOFA > 12 and APACHE II ≥ 20) on the day of admission, adjusting for relevant comorbidities, bilirubin, and platelet count. Additionally, KIM-1 in multivariate regression was able to predict sepsis in patients without prior (CKD) or present (AKI) kidney injury. Our study suggests that next to its established role as a biomarker in kidney dysfunction, KIM-1 is associated with sepsis, biliary injury, and critical illness severity. It thus may offer aid for risk stratification in these patients.
摘要：
肾损伤分子（KIM）-1在急性肾损伤（AKI）中从近端肾小管细胞脱落，中继肾小管上皮增殖。此外,KIM-1预示着复杂的免疫调节，并在暴露于脂多糖后升高。因此，它可能代表危重疾病的生物标志物，脓毒症,和脓毒症相关AKI（SA-AKI）。要在这些设置中表征和比较KIM-1，我们分析了入住重症监护病房的192例危重患者的KIM-1血清浓度.不管肾功能障碍，与其他危重疾病相比，败血症患者的KIM-1血清水平明显更高（191.6vs.132.2pg/mL,p=0.019），在泌尿生殖道败血症患者中最高，其次是肝功能衰竭。此外，在48小时内发生AKI的危重患者中，KIM-1水平显着升高（273.3vs.125.8pg/mL,p=0.026）或以后接受肾脏替代治疗（RRT）（299.7vs.146.3pg/mL,p<0.001)。KIM-1与肾功能标志物相关，炎症参数，造血功能,和胆管细胞损伤。在SOFA分数的子组成部分中，高胆红素血症患者KIM-1升高（>2mg/dL，p<0.001）和血小板减少症（<150/nL，p=0.018)。在单变量和多元回归分析中，KIM-1预测脓毒症，对RRT的需求，和多器官功能障碍(MOD，SOFA>12和APACHEII≥20）在入院当天，调整相关合并症，胆红素,和血小板计数。此外,多变量回归分析中的KIM-1能够预测没有先前(CKD)或存在(AKI)肾损伤的患者的脓毒症。我们的研究表明，除了其作为肾功能不全的生物标志物的作用外，KIM-1与脓毒症有关,胆道损伤,和严重的疾病。因此，它可以为这些患者的风险分层提供帮助。
