在接受心脏手术的患者中,急性损伤和随后的功能丧失之间的关联:观察队列研究
Stefan J Schunk1, Alexander Zarbock2, Melanie Meersch2
1Department of Internal Medicine 4, Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany.
Lancet (London, England)
|June 17, 2019
概括
在心脏手术后的急性损伤 (AKI) 有效预测. 高DKK3水平表明AKI和长期功能丧失的风险更大,有助于患者的风险分层.
科学领域:
- 肝脏病学
- 心脏病学
- 生物标志物研究
背景情况:
- 心脏手术具有严重的术后急性损伤 (AKI) 和逐渐下降的功能.
- 在手术前确定易受 AKI 影响的患者对于及时实施干预措施至关重要.
研究的目的:
- 评估尿管压力标志物dickkopf-3 (DKK3) 在心脏手术患者中预测AKI和随后的功能丧失的临床效用.
主要方法:
- 一项观察性队列研究,涉及心脏手术患者的导出和验证队列 (RenalRIP试验).
- 评估了手术前尿道DKK3与肌素比率 (DKK3:肌素) 和术后AKI (KDIGO标准) 和功能损失 (eGFR) 之间的关联.
主要成果:
- 在手术前尿中DKK3的升高 (> 471 pg/ mg) 独立预测了AKI风险的增加和退院后和长期的功能恶化.
- 与现有的临床和实验室标志物相比,尿液DKK3:肌素显著改善了AKI预测.
- 在验证队列中,高DKK3:肌素预测了AKI,持续性功能障碍和透析依赖性,特别是在假手术组中.
结论:
- 术前尿道DKK3作为术后AKI和心脏手术后持续性功能损失的独立预测指标.
- 尿液DKK3测量可以识别可能受益于预防策略来减轻AKI风险的患者.
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