Chang and predictive efficacy of new biomarkers for acute kidney injury in the early stage of multiple trauma_West China Medical Journal

Authors：

LIU Dan ,  LIU Jining , ZHU Lungang , HUANG Bin

Emergency Department, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

LIU Jining, Email: 310603510@qq.com

Keywords：

Multiple trauma; Acute kidney injury; New biomarkers; Predictive efficacy

DOI：

10.7507/1002-0179.202110062

Video：

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Objective To explore the change of serum levels of neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP-7) in the early stage of multiple trauma, and their predictive efficacy for acute kidney injury (AKI). Methods The multiple trauma patients admitted between February 2020 and July 2021 were prospectively selected, and they were divided into AKI group and non-AKI group according to whether they developed AKI within 72 h after injury. The serum levels of NGAL, TIMP-2, and IGFBP-7 measured at admission and 12, 24, and 48 h after injury, the Acute Pathophysiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, intensive care unit duration, rate of renal replacement therapy, and 28-day mortality rate were compared between the two groups. Results A total of 51 patients were included, including 20 in the AKI group and 31 in the non-AKI group. The APACHE Ⅱ at admission (20.60±3.57 vs. 11.61±3.44), intensive care unit duration [(16.75±2.71) vs. (11.13±3.41) d], rate of renal replacement therapy (35.0% vs. 0.0%), and 28-day mortality rate (25.0% vs. 3.2%) in the AKI group were higher than those in the non-AKI group (P<0.05). The serum levels of NGAL and IGFBP-7 at admission and 12, 24, and 48 h after injury in the AKI group were all higher than those in the non-AKI group (P<0.05). For the prediction of AKI, the areas under receiver operating characteristic curves and 95% confidence intervals of serum NGAL, TIMP-2 and IGFBP-7 12 h after injury were 0.98 (0.96, 1.00), 0.92 (0.83, 1.00), and 0.87 (0.78, 0.97), respectively. Conclusion Serum NGAL, TIMP-2, and IGFBP-7 have high predictive efficacy for AKI secondary to multiple trauma, and continuous monitoring of serum NGAL can be used for early prediction of AKI secondary to multiple trauma.

Citation： LIU Dan, LIU Jining, ZHU Lungang, HUANG Bin. Chang and predictive efficacy of new biomarkers for acute kidney injury in the early stage of multiple trauma. West China Medical Journal, 2021, 36(11): 1528-1532. doi: 10.7507/1002-0179.202110062 Copy

1.	World Health Organization‎. Global status report on road safety 2018: Summary: CC BYNC-SA 30 IGO. Geneva: World Health Organization, 2018.
2.	Kellum JA, Lameire N, Aspelin P, et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
3.	Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med, 2007, 35(8): 1837-1843.
4.	Sancho-Martínez SM, Blanco-Gozalo V, Quiros Y, et al. Impaired tubular reabsorption is the main mechanism explaining increases in urinary NGAL excretion following acute kidney injury in rats. Toxicol Sci, 2020, 175(1): 75-86.
5.	中华医学会创伤分会创伤急救与多发伤组. 多发伤病历与诊断: 专家共识意见. 创伤外科杂志, 2010, 12(1): 96-封 3.
6.	Santos PR, Monteiro DL. Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study. BMC Nephrol, 2015, 16: 30.
7.	李楠, 王恒进, 蒋春明, 等. 多发伤后急性肾损伤的危险因素分析及其对预后的影响. 创伤外科杂志, 2016, 18(11): 675-677.
8.	Kohagura K, Ohya Y. Early detection and prediction by biomarkers of acute kidney injury after cardiac surgery. Circ J, 2012, 76(1): 53-54.
9.	彭艳, 邹鑫森. 早期连续性肾脏替代治疗对严重多发伤合并急性肾损伤预后影响的临床研究. 中国全科医学, 2020, 23(26): 3269-3273.
10.	陈超逸, 赵弯弯, 黄婷, 等. NGAL 与急性肾损伤患者的临床相关性分析. 医学信息, 2021, 34(15): 50-53.
11.	王俊贤, 张素敏, 杨小兵. 新型急性肾损伤生物标记物预测急性肾损伤发展及预后的研究进展. 实用医学杂志, 2017, 33(15): 2598-2600.
12.	Kjeldsen L, Johnsen AH, Sengeløv H, et al. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase. J Biol Chem, 1993, 268(14): 10425-10432.
13.	Devarajan P. Emerging biomarkers of acute kidney injury. Contrib Nephrol, 2007, 156: 203-212.
14.	许慧慧, 吴维雄, 于航, 等. 老年脓毒症诱发急性肾损伤患者血清 NGAL、CysC 水平变化及诊断价值研究. 中国实验诊断学, 2020, 24(7): 1138-1140.
15.	Buonafine M, Martinez-Martinez E, Jaisser F. More than a simple biomarker: the role of NGAL in cardiovascular and renal diseases. Clin Sci (Lond), 2018, 132(9): 909-923.
16.	张继松, 王聿明, 郑彦俊, 等. NGAL 对脓毒症/脓毒症休克患者预后的预测价值. 中华卫生应急电子杂志, 2020, 6(4): 202.
17.	彭燕, 许华, 王兵, 等. 血清 NGAL 联合乳酸及 APACHE Ⅱ评分对脓毒性休克合并急性肾损伤患者病死的预测价值. 天津医科大学学报, 2021, 27(4): 365-368.
18.	Cho WY, Lim SY, Yang JH, et al. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 as biomarkers of patients with established acute kidney injury. Korean J Intern Med, 2020, 35(3): 662-671.
19.	Aregger F, Uehlinger DE, Witowski J, et al. Identification of IGFBP-7 by urinary proteomics as a novel prognostic marker in early acute kidney injury. Kidney Int, 2014, 85(4): 909-919.
20.	Gocze I, Koch M, Renner P, et al. Urinary biomarkers TIMP-2 and IGFBP7 early predict acute kidney injury after major surgery. PLoS One, 2015, 10(3): e0120863.
21.	Ronco C. Acute kidney injury: from clinical to molecular diagnosis. Crit Care, 2016, 20(1): 201.
22.	Devarajan P. Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol, 2006, 17(6): 1503-1520.
23.	Waikar SS, Betensky RA, Emerson SC, et al. Imperfect gold standards for kidney injury biomarker evaluation. J Am Soc Nephrol, 2012, 23(1): 13-21.
24.	Kashani K, Al-Khafaji A, Ardiles T, et al. Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care, 2013, 17(1): R25.

1. World Health Organization‎. Global status report on road safety 2018: Summary: CC BYNC-SA 30 IGO. Geneva: World Health Organization, 2018.
2. Kellum JA, Lameire N, Aspelin P, et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
3. Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med, 2007, 35(8): 1837-1843.
4. Sancho-Martínez SM, Blanco-Gozalo V, Quiros Y, et al. Impaired tubular reabsorption is the main mechanism explaining increases in urinary NGAL excretion following acute kidney injury in rats. Toxicol Sci, 2020, 175(1): 75-86.
5. 中华医学会创伤分会创伤急救与多发伤组. 多发伤病历与诊断: 专家共识意见. 创伤外科杂志, 2010, 12(1): 96-封 3.
6. Santos PR, Monteiro DL. Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study. BMC Nephrol, 2015, 16: 30.
7. 李楠, 王恒进, 蒋春明, 等. 多发伤后急性肾损伤的危险因素分析及其对预后的影响. 创伤外科杂志, 2016, 18(11): 675-677.
8. Kohagura K, Ohya Y. Early detection and prediction by biomarkers of acute kidney injury after cardiac surgery. Circ J, 2012, 76(1): 53-54.
9. 彭艳, 邹鑫森. 早期连续性肾脏替代治疗对严重多发伤合并急性肾损伤预后影响的临床研究. 中国全科医学, 2020, 23(26): 3269-3273.
10. 陈超逸, 赵弯弯, 黄婷, 等. NGAL 与急性肾损伤患者的临床相关性分析. 医学信息, 2021, 34(15): 50-53.
11. 王俊贤, 张素敏, 杨小兵. 新型急性肾损伤生物标记物预测急性肾损伤发展及预后的研究进展. 实用医学杂志, 2017, 33(15): 2598-2600.
12. Kjeldsen L, Johnsen AH, Sengeløv H, et al. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase. J Biol Chem, 1993, 268(14): 10425-10432.
13. Devarajan P. Emerging biomarkers of acute kidney injury. Contrib Nephrol, 2007, 156: 203-212.
14. 许慧慧, 吴维雄, 于航, 等. 老年脓毒症诱发急性肾损伤患者血清 NGAL、CysC 水平变化及诊断价值研究. 中国实验诊断学, 2020, 24(7): 1138-1140.
15. Buonafine M, Martinez-Martinez E, Jaisser F. More than a simple biomarker: the role of NGAL in cardiovascular and renal diseases. Clin Sci (Lond), 2018, 132(9): 909-923.
16. 张继松, 王聿明, 郑彦俊, 等. NGAL 对脓毒症/脓毒症休克患者预后的预测价值. 中华卫生应急电子杂志, 2020, 6(4): 202.
17. 彭燕, 许华, 王兵, 等. 血清 NGAL 联合乳酸及 APACHE Ⅱ评分对脓毒性休克合并急性肾损伤患者病死的预测价值. 天津医科大学学报, 2021, 27(4): 365-368.
18. Cho WY, Lim SY, Yang JH, et al. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 as biomarkers of patients with established acute kidney injury. Korean J Intern Med, 2020, 35(3): 662-671.
19. Aregger F, Uehlinger DE, Witowski J, et al. Identification of IGFBP-7 by urinary proteomics as a novel prognostic marker in early acute kidney injury. Kidney Int, 2014, 85(4): 909-919.
20. Gocze I, Koch M, Renner P, et al. Urinary biomarkers TIMP-2 and IGFBP7 early predict acute kidney injury after major surgery. PLoS One, 2015, 10(3): e0120863.
21. Ronco C. Acute kidney injury: from clinical to molecular diagnosis. Crit Care, 2016, 20(1): 201.
22. Devarajan P. Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol, 2006, 17(6): 1503-1520.
23. Waikar SS, Betensky RA, Emerson SC, et al. Imperfect gold standards for kidney injury biomarker evaluation. J Am Soc Nephrol, 2012, 23(1): 13-21.
24. Kashani K, Al-Khafaji A, Ardiles T, et al. Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care, 2013, 17(1): R25.

West China Medical Journal

Chang and predictive efficacy of new biomarkers for acute kidney injury in the early stage of multiple trauma

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