尿液[TIMP-2]×[IGFBP-7]用于心脏手术后预测急性肾损伤的评价：灰色区域法
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Interest of Urinary [TIMP-2] × [IGFBP-7] for Predicting the Occurrence of Acute Kidney Injury After Cardiac Surgery: A Gray Zone Approach
背景与目的
本研究评估了进行体外循环的心脏手术患者术后3小时尿液中基质金属蛋白酶组织抑制剂-2（TIMP-2）×胰岛素样生长因子结合蛋白-7（[TIMP-2]×[IGFBP-7]）预测术后急性肾损伤（AKI）的能力。
方 法
接受心肺旁路心脏手术的患者纳入本研究。排除患者为慢性肾功能不全需要肾脏替代治疗的患者，<18岁的患者和分娩者。麻醉和血液动力学管理遵循当前实践。在术后3小时测量尿[TIMP2]×[IGFBP-7]。主要目标是术后48小时内发生AKI（肾脏疾病：术后48小时内改善全局结果[KDIGO]阶段>0）。通过建立接受者操作特征曲线（95％置信区间[95％CI]）和灰色区域法，允许预测或排除术后AKI（灵敏度>0.90，特异性>0.90）以评估尿[TIMP-2]×[IGFBP-7]预测术后AKI的能力。
结 果
93例患者中有34例（37％）发生AKI，尿[TIMP-2]×[IGFBP-7]接受者操作特征曲线为0.73（95％CI，0.62〜0.83），尿[TIMP-2]×[IGFBP-7]在预测AKI中的临界值为0.3ng / mL2 / 1000 [0.09-1.40]（灵敏度= 76％; 95％CI，73-97，特异性= 64％; 95％CI，42-69）。尿[TIMP-2]×[IGFBP-7]<0.09 ng / mL2 / 1000和> 1.40 ng / mL2 / 1000在术后AKI预测中的敏感性和特异度> 90％。五十九名患者（63％）在灰色区域内。
结 论
在进行心肺转流的心脏手术患者中，尿[TIMP-2]×[IGFBP-7]无法准确预测术后急性肾损伤的发生。
原始文献摘要
Toufic Finge,Sebastien Bertran,Claire Roger,et al.Interest of Urinary [TIMP-2]×[IGFBP-7] for Predicting the Occurrence of Acute Kidney Injury After Cardiac Surgery:A Gray Zone Approach. AnesthAnalg.Sep2017;125(3):762769.doi:10.1213/ANE.0000000000002116.
BACKGROUND: This study assessed the ability of 3-hour postoperative urinary tissue inhibitor of metalloproteinases-2×insulin-like growth factor binding protein-7([TIMP-2]×[IGFBP-7]) to predict postoperative acute kidney injury (AKI) in patients undergoing cardiopulmonary bypass during cardiac surgery.
METHODS: Patients undergoing cardiac surgery with cardiopulmonary bypass were eligible for this study. Patients with initial chronic renal insufficiency requiring renal replacement therapy,patients<18 years of age, and parturients were not included. Anesthesia and hemodynamic management followed current practices. Urinary [TIMP2]×[IGFBP-7] was measured in 3-hour postoperative period.The primary objective was the occurrence of AKI (Kidney Disease:Improving Global Outcome [KDIGO] stage >0) within the first 48 hours postoperatively.The ability of urinary [TIMP-2]×[IGFBP-7] to predict postoperative AKI was assessed by building a receiver operating characteristic curve (with 95% confidence interval [95% CI] and by a gray zone approach that allowed either the prediction or the exclusion of postoperative AKI with a sensitivity >0.90 and a specificity>0.90.
RESULTS: AKI occurred in 34 of 93 patients included (37%).The area under the receiver operating characteristic curve of urinary [TIMP-2]× [IGFBP-7] was 0.73 (95% CI, 0.62–0.83).The best cutoff value for urinary [TIMP-2]×[IGFBP-7] in predicting AKI was 0.3 ng/mL2/1000 [0.09–1.40] (sensitivity = 76%; 95% CI, 73–97, specificity= 64%; 95% CI, 42–69). Urinary [TIMP-2]×[IGFBP-7] of <0.09 ng/mL2/1000 and >1.40 ng/mL2/1000 had a sensitivity and specificity>90% in predicting postoperative AKI. Fifty-nine patients (63%) were within the gray zone.
CONCLUSIONS: In patients undergoing cardiopulmonary bypass during cardiac surgery,urinary[TIMP-2]×[IGFBP-7] could not accurately predict the occurrence of postoperative AKI.
麻醉学文献进展分享
联系我们