Acute Kidney Injury Biomarkers for Patients in a Coronary Care Unit A Prospective Cohort Study 英文参考文献.docVIP

AcuteKidneyInjuryBiomarkersforPatientsina CoronaryCareUnit:AProspectiveCohortStudy Tien-HsingChen1.,Chih-HsiangChang2.,Chan-YuLin2,Chang-ChyiJenq2,3,Ming-YangChang2,3 , Ya-ChungTian2,3,Cheng-ChiehHung2,3,Ji-TsengFang2,3,Chih-WeiYang2,3,Ming-ShienWen1,3 , Fun-ChungLin1,3,Yung-ChangChen2,3 * 1SecondSectionofCardiology,ChangGungMemorialHospital,Taipei,Taiwan,2DepartmentofNephrology,ChangGungMemorialHospital,Taipei,Taiwan,3Chang GungUniversityCollegeofMedicine,Taipei,Taiwan Abstract Background:Renaldysfunctionisanestablishedpredictorofall-causemortalityinintensivecareunits.Thisstudyanalyzedthe outcomes of coronary care unit (CCU) patients and evaluated several biomarkers of acute kidney injury (AKI), including neutrophilgelatinase-associatedlipocalin(NGAL),interleukin-18(IL-18)andcystatinC(CysC)onthefirstdayofCCUadmission. Methodology/Principal Findings: Serum and urinary samples collected from 150 patients in the coronary care unit of a tertiary care university hospital between September 2009 and August 2010 were tested for NGAL, IL-18 and CysC. Prospectivedemographic,clinicalandlaboratorydatawereevaluatedaspredictorsofsurvivalinthispatientgroup.The mostcommoncauseofCCUadmissionwasacutemyocardialinfarction(80%).AccordingtoAcuteKidneyInjuryNetwork criteria,28.7%(43/150)ofCCUpatientshadAKIofvaryingseverity.Cumulativesurvivalratesat6-monthfollow-upfollowing hospitaldischargedifferedsignificantly(p,0.05)betweenpatientswithAKIversusthosewithoutAKI.ForpredictingAKI, serumCysCdisplayedanexcellentareasunderthereceiveroperatingcharacteristiccurve(AUROC)(0.89560.031,p,0.001). Theoverall180-daysurvivalratewas88.7%(133/150).MultipleCoxlogisticregressionhazardanalysisrevealedthaturinary NGAL,serumIL-18,AcutePhysiology,AgeandChronicHealthEvaluationII(APACHEII)andsodiumonCCUadmissionday one were independent risk factors for 6-month mortality. In terms of 6-month mortality, urinary NGAL had the best discriminatorypower,thebestYoudenindex,andthehighestoverallcorrectnessofprediction.