基于生物标志物的急性损伤亚现象改进了接受心脏手术的儿童的风险评估
Kevin A Pettit1, Katherine F Melink2, Jeffrey A Alten2
1Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, CO, USA. kevin.pettit@childrenscolorado.org.
Pediatric nephrology (Berlin, Germany)
|September 27, 2024
概括
即使没有肌素变化,早期尿NGAL测试也有助于识别心脏手术后患损伤风险较高的儿童. 这种生物标志物可以改善儿童心脏手术相关急性损伤 (CS-AKI) 的早期检测和预后.
科学领域:
- 在儿科重症监护中发现和验证生物标志物.
- 急性损伤病理生理学和临床结果.
- 儿童心脏手术和重症监护医学.
背景情况:
- 儿童心脏手术相关的急性损伤 (CS-AKI) 是常见的,但其与结果的关联是可变的.
- 暂时的血清肌素升高可能不准确地反映损伤.
- 使用尿中性粒细胞凝酶相关性脂卡林 (uNGAL) 等生物标志物进行CS-AKI亚表型化可能会提高预后准确性.
研究的目的:
- 为了确定是否将早期的uNGAL和血清肌素 (SCr) 结合到子表型中,可以加强与AKI和临床结果的关联.
- 假设特定的uNGAL/SCr表型预测术后AKI和更糟糕的结果.
主要方法:
- 一个两中心的前性观察研究.
- 评估了早期uNGAL (8-12h ICU入院后) 和早期术后KDIGO SCr定义的AKI (≤8h入院后) 的组合.
- 导出了四种CS-AKI表型: uNGAL-/SCr-, uNGAL+/SCr-, uNGAL-/SCr+和 uNGAL+/SCr+;主要结果是POD2-4 KDIGO SCr定义的CS-AKI.
主要成果:
- 包括476名患者;9.2%的人患有POD2-4 AKI.
- 与uNGAL-/SCr-.相比,uNGAL+/SCr-表型显示POD2-4 AKI的调整后几率是uNGAL-/SCr-.的九倍.
- 患有uNGAL+/SCr-表型患者的无呼吸器和无ICU日数显著减少.
结论:
- 早期手术后的uNGAL测量,无论SCr水平如何,完善了对儿科CS-AKI的风险评估.
- 这种方法可以更早地识别和预测AKI和相关的发病率.
- 生物标志物整合有助于理解CS-AKI亚表型及其临床影响.
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