Objective To evaluate whether the serum neutrophil gelatinase associated lipocalin ( sNGAL) , urinary neutrophil gelatinase lipocalin(uNGAL) , urinary interleukin-18 ( uIL-18) or urinary kidney injury molecule-1 ( uKIM-1 ) can predict the need for renal replacement therapy ( RRT) in patients with septic acute kidney injury (AKI). Methods A prospective observational study was conducted in patients with septic AKI whose expected ICU stay ^ 24 h. AKI was defined by American Kidney Injury (AKIN) criteria during the 48 h after admission, while sNGAL, uNGAL, uIL-18 and uKIM-1 were determined at the enrollment. Test characteristics were calculated to assess the diagnostic performance of these biomarkers. Results Forty-five patients were studied, RRT was initiated in 12 patients with septic AKI in the first 7 days. Two groups were defined according to the need of RRT; RRT group(ra=12) and non-RRT group(n=33). RRT group had higher median uNGAL level compared to non-RRT group(912. 0 vs 218. 0 ng/mL, P<0. 001). The predicting performance for uNGAL was good( AUC 0. 88), and that of sNGAL, uIL-18 and uKIM-1 was poor( AUC 0. 68,0. 69,0. 67, respectively). Conclusion uNGAL might be a good biomarker for predicting the need of RRT in patients with septic AKI.%目的 通过测定感染性急性肾损伤患者血清中性粒细胞胶原酶相关脂质运载蛋白(serum neutrophil gelatinase associated lipocalin,sNGAL)、尿中性粒细胞胶原酶相关脂质运载蛋白(urinary neutrophil gelatinase lipocalin,uNGAL)、尿肾损伤因子-1(urinary kidney injury molecule-1,uKIM-1)、尿白细胞介素-18(urinary interleukin-18,uIL-18)浓度,评价上述生物学标志物对感染性急性肾损伤患者接受肾脏替代治疗(renal replacement therapy,RRT)的预测作用.方法 预计入住重症监护病房(intensive care unit,ICU)时间≥24 h的全身性感染患者,并于入组48 h内存在或出现急性肾损伤.测定患者入组时sNGAL、uNGAL、uIL-18、uKIM-1浓度.根据入组7日内是否应用RRT,将入组患者分为RRT组和非RRT组,比较2组间生物学标志物浓度的差异,绘制受试者工作特征曲线,评价生物学标志物对感染性急性肾损伤应用RRT的预测价值.结果 入选感染性急性肾损伤患者45例,其中12例(26.7％)患者应用RRT.RRT组uNGAL显著高于非RRT组(912.0 ng/mL vs 218.0 ng/mL,P＜0.001),2组间sNGAL、uIL-18、uKIM-1浓度差异无统计学意义.uNGAL预测感染性急性肾损伤患者应用RRT的曲线下面积为0.88.结论 uNGAL可能适合成为预测感染性急性肾损伤患者是否接受RRT的生物学标志物.
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