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Integration of urinary neutrophil gelatinase-associated lipocalin with serum creatinine delineates acute kidney injury phenotypes in critically ill children.

Abstract：

PURPOSE:Acute kidney injury (AKI) is prevalent in critically ill patients and associated with poor outcomes. Current AKI diagnostics- changes to serum creatinine (SCr) and urine output- are imprecise. Integration of injury biomarkers with SCr may improve diagnostic precision. METHODS:We performed a secondary analysis of a study of critically ill children. Measurements of urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr samples from ICU admission facilitated the creation of four groups for comparison, based on elevation of SCr from baseline and reference NGAL cut-off value: uNGAL-/SCr-, uNGAL+/SCr-, uNGAL-/SCr + and uNGAL+/SCr+. The primary outcome assessed was AKI severity on Day 3. RESULTS:178 children were studied. Compared to uNGAL-/SCr-, uNGAL+/SCr- patients had increased risk for all-stage Day 3 AKI (≥ KDIGO stage 1) (OR 3.83, [1.3-11.3], p = .025). Compared to uNGAL-/SCr+, uNGAL+/SCr + patients had increased risk for severe Day 3 AKI (≥ KDIGO stage 2) (OR 12, [1.4-102], p = .018). The only patients to suffer all-stage Day 3 AKI and mortality were uNGAL+ (3.2% uNGAL+/SCr-; 6.5% uNGAL+/SCr+). CONCLUSIONS:Unique biomarker combinations on admission are predictive of distinct Day 3 AKI severity phenotypes. These classifications may enable a more personalized approach to the early management of AKI. Expanded study in larger populations is warranted.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Stanski N,Menon S,Goldstein SL,Basu RK

doi

10.1016/j.jcrc.2019.05.017

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

1-7

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(19)30252-7

journal_volume

53

pub_type

杂志文章

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