术前N末端-B型利钠肽原水平预测非心脏手术后急性肾损伤：一项回顾性队列研究

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术前N末端-B型利钠肽原水平预测非心脏手术后急性肾损伤：一项回顾性队列研究

贵州医科大学 高鸿教授课题组

翻译：佟睿    编辑：佟睿    审校：曹莹

  背景        

急性肾损伤(AKI)与非心脏手术后预后不良有关。术前N端-B型利钠肽原(NT-proBNP)水平是否能预测非心脏手术后AKI尚不清楚。

目的        

探讨术前NT-proBNP水平对术后急性肾损伤(AKI)的预测作用。

试验设计        

回顾性队列研究。

范围设置        

中国南方医科大学南方医院。

受试人群        

纳入在2008年2月至2018年5月期间，在非心脏手术后30天内进行了血清肌酐和NT-proBNP测定、并在非心脏手术后7天内至少进行了一次血清肌酐测定的成年患者。

主要观察指标测定        

主要观察指标是术后AKI，由改善全球肾脏病预后组织（KDIGO）提出的肌酐标准诊断。

结果        

总体而言，6.1%(7248例中的444例)患者在术后1周内发生AKI。调整临床变量后，术前NT-proBNP是急性肾损伤的独立预测因子(趋势OR为2.29，95%CI为1.47~3.65，P<0.001；自然对数每单位增量OR为1.27，95%CI为1.16~1.39)。与单纯临床变量相比，NT-ProBNP改善了模型拟合，适度提高了急性肾损伤和非急性肾损伤患者的判别能力(曲线下面积变化从0.764到0.773，P=0.005)和再分类能力(持续净再分类提高0.210，95%CI，0.111到0.308，综合判别能力提高0.0044，95%CI，0.0016到0.0072)，在决策曲线分析中获得了更高的净效益。

结论        

术前NT-proBNP浓度提供了一组接受非心脏手术的患者AKI的预测性信息，这些患者独立于传统的危险因素，且随常规危险因素的增加而递增。需要进行前瞻性研究来证实这一发现并检查其临床影响。

试验登记        

中国临床试验登记, ChiCTR1900024056. www.chictr.org.cn/showproj.aspx? proj=40385.

Pre-operative N-terminal pro-B-type natriuretic peptide

for prediction of acute kidney injury after

noncardiac surgery: A retrospective cohort study

BACKGROUND Acute kidney injury (AKI) is associated with poor outcomes after noncardiac surgery. Whether pre-operative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after noncardiac surgery is unclear.

OBJECTIVE To investigate the predictive role of pre-operative NT-proBNP on postoperative AKI.

DESIGN Retrospective cohort study.

SETTING Nanfang Hospital, Southern Medical University, China.

PATIENTS Adult patients who had a serum creatinine and NT-proBNP measurement within 30 pre-operative days and at least one serum creatinine measurement within 7 days after noncardiac surgery between February 2008 and May 2018 were identified.

MAIN OUTCOME MEASURES The primary outcome was postoperative AKI, defined by the kidney disease: improving global outcomes creatinine criteria.

RESULTS In all, 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Pre-operative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (OR comparing top to bottom quintiles 2.29, 95% CI, 1.47 to 3.65, P<0.001 for trend; OR per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI, 1.16 to 1.39). Compared with clinical variables alone, the addition of NT-proBNP improved model fit, modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, P=0.005) and reclassification (continuous net reclassificationimprovement0.210,95%CI, 0.111 to 0.308, improved integrated discrimination 0.0044, 95% CI, 0.0016 to 0.0072) of AKI and non-AKI cases, and achieved higher net benefit in decision curve analysis.

CONCLUSIONS Pre-operative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing noncardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact.

TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900024056. www.chictr.org.cn/showproj.aspx? proj=40385.