在危重病人中血浆内皮抑素可能能改善急性肾损伤的风险预测

英文标题： Plasma endostatin may improve acute kidney injury risk prediction in critically ill patients
作者： Johan Mårtensson,corresponding author Niklas Jonsson, Neil J. Glassford, Max Bell, Claes-Roland Martling, Rinaldo Bellomo, and Anders Larsson
作者单位： Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden
DOI： 10.1186/s13613-016-0108-x
PMID： PMC4712179
出版年份： 2016年 收录者： Pubmed/MEDLINE
摘要： 肾脏内皮细胞、肾小管和肾小球基质细胞的分解在急性肾脏损伤(AKI)的发展中发挥重要的作用。这种胶原的分解能释放内皮抑素到循环中。该研究的目的是对比血浆内皮抑素在AKI中的预测价值和两个之前提出的AKI的生物标记物胱抑素C和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。 方法：我们研究了93例无肾脏疾病的患者在ICU入院的48小时内采取批血浆样本。我们鉴定这这些群体内AKI的风险因子并设计预测模型。通过受试者工作特征曲线下的面积（AUC）、似然比检测、分级的改善（NRI）和整体差异的改善（IDI）来评估个体的能力和内皮抑素、胱抑素C和NGAL来预测AKI。结果：总体来说21 (23 %)的患者在72小时内经历AKI。3参数模型（年龄、疾病严重性分值和早期少尿）预测AKI，AUC为0.759 (95 % CI 0.646-0.872)。增加内皮抑素到预测模型中显著改善AUC到0.839。此外，使用似然比检测、NRI分析和IDI分析内皮抑素显著改善风险预测。相反，增加胱抑素C或是NGAL到3参数模型中不能改善任何4个分析的风险预测。结论：在这群危重病人中，依据临床风险因子血浆内皮抑素改善AKI的预测，但是胱抑素C和NGAL不能。
Background Breakdown of renal endothelial, tubular and glomerular matrix collagen plays a major role in acute kidney injury (AKI) development. Such collagen breakdown releases endostatin into the circulation. The aim of this study was to compare the AKI predictive value of plasma endostatin with two previously suggested biomarkers of AKI, cystatin C and neutrophil gelatinase-associated lipocalin (NGAL). Methods We studied 93 patients without kidney disease who had a first plasma sample obtained within 48 h of ICU admission. We identified risk factors for AKI within the population and designed a predictive model. The individual ability and net contribution of endostatin, cystatin C and NGAL to predict AKI were evaluated by the area under the receiver operating characteristics curve (AUC), likelihood-ratio test, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results In total, 21 (23 %) patients experienced AKI within 72 h. A three-parameter model (age, illness severity score and early oliguria) predicted AKI with an AUC of 0.759 (95 % CI 0.646–0.872). Adding endostatin to the predictive model significantly (P = 0.04) improved the AUC to 0.839 (95 % CI 0.752–0.925). In addition, endostatin significantly improved risk prediction using the likelihood-ratio test (P = 0.005), NRI analysis (0.27; P = 0.04) and IDI analysis (0.07; P = 0.04). In contrast, adding cystatin C or NGAL to the three-parameter model did not improve risk prediction in any of the four analyses. Conclusions In this cohort of critically ill patients, plasma endostatin improved AKI prediction ba[x]sed on clinical risk factors, while cystatin C and NGAL did not. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0108-x) contains supplementary material, which is available to authorized users.