背景:在重症监护病房(ICU)患者中,尚未很好地确定急性肾损伤(AKI)生物标志物随时间变化的轨迹的临床价值。
方法:这是一个单中心,前瞻性观察研究,在东京一所教学医学院的混合ICU演出,日本。2014年9月至2015年3月纳入成人ICU动脉导管和尿道导管患者。在ICU中停留少于48小时的患者和已知终末期肾病的患者被排除在研究之外。在ICU入院后0、12、24和48小时收集血液和尿液样品用于AKI生物标志物的测量。主要结果是出院时的主要不良肾脏事件(MAKE),定义为死亡的复合物,透析依赖性,和持续肾功能丧失(eGFR下降≥25%)。
结果:该研究包括156名患者。基于血清肌酐的估计肾小球滤过率(eGFR),血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL),和尿肝型脂肪酸结合蛋白(uL-FABP)进行连续测量,并根据基于组的轨迹建模分析将每个变量分为三组.当轨迹曲线彼此平行移动时(即,\"低,\"\"中间,\"和\"高\")对于eGFR和血浆NGAL,uL-FABP曲线显示出不同的轨迹模式,并在不同的方向上移动(“低和恒定,“\”高和指数下降,\"和\"高和指数增长\")。这些轨迹模式与MAKE显著相关。MAKE发生在16(18%),16(40%),和9名(100%)患者在低和恒定,“\”高和指数下降,\"和\"高和指数增长\"组,分别,基于uL-FABP水平(p值<0.001)。uL-FABP的初始值和12小时变化均与MAKE显著相关,即使在调整了eGFR[赔率比(95%置信区间)之后:1.45(1.17-1.83)和1.43(1.12-1.88)对于初始值的增加和对数转换的uL-FABP的12小时变化1点,分别]。
结论:ICU患者连续测量尿L-FABP的轨迹模式与MAKE显著相关。
BACKGROUND: The clinical value of the trajectory of temporal changes in acute kidney injury (AKI) biomarkers has not been well established among intensive care unit (ICU) patients.
METHODS: This is a single-center, prospective observational study, performed at a mixed ICU in a teaching medical institute in Tokyo, Japan. Adult ICU patients with an arterial line and urethral catheter were enrolled from September 2014 to March 2015. Patients who stayed in the ICU for less than 48 h and patients with known end-stage renal disease were excluded from the study. Blood and urine samples were collected for measurement of AKI biomarkers at 0, 12, 24, and 48 h after ICU admission. The primary outcome was major adverse kidney events (MAKE) at discharge, defined as a composite of death, dialysis dependency, and persistent loss of kidney function (≥ 25% decline in eGFR).
RESULTS: The study included 156 patients. Serum creatinine-based estimated glomerular filtration rate (eGFR), plasma neutrophil gelatinase-associated lipocalin (NGAL), and urinary liver-type fatty acid-binding protein (uL-FABP) were serially measured and each variable was classified into three groups based on group-based trajectory modeling analysis. While the trajectory curves moved parallel to each other (i.e., \"low,\" \"middle,\" and \"high\") for eGFR and plasma NGAL, the uL-FABP curves showed distinct trajectory patterns and moved in different directions (\"low and constant,\" \"high and exponential decrease,\" and \"high and exponential increase\"). These trajectory patterns were significantly associated with MAKE. MAKE occurred in 16 (18%), 16 (40%), and 9 (100%) patients in the \"low and constant,\" \"high and exponential decrease,\" and \"high and exponential increase\" groups, respectively, based on uL-FABP levels (p-value < 0.001). The initial value and the 12-h change in uL-FABP were both significantly associated with MAKE, even after adjusting for eGFR [Odds ratio (95% confidence interval): 1.45 (1.17-1.83) and 1.43 (1.12-1.88) for increase of initial value and 12-h change of log-transformed uL-FABP by 1 point, respectively].
CONCLUSIONS: Trajectory pattern of serially measured urinary L-FABP was significantly associated with MAKE in ICU patients.