Intens Care Med:预测急性肾损伤肾脏替代治疗的生物标志物!

2018-03-20 xing.T MedSci原创

由此可见,虽然一些生物标志物表明AKI的危重患者对RRT使用具有有前景和合理的预测,但目前的证据强度无法用于常规指导决策在何时开始RRT治疗。

急性肾损伤(AKI)经常发生在危重患者中,往往需要进行肾脏替代治疗(RRT)。然而,对于是否以及何时开始RRT的理想时机仍不清楚。近日,危重病医学领域权威杂志Intensive Care Medicine上发表了一篇研究文章,研究人员对现有的文献证据综合评价以预测AKI患者需要进行RRT的生物标志物的价值。

研究人员进行了一项系统回顾和荟萃分析,通过系统检索了MEDLINE、EMBASE与CENTRAL数据库,检索时间从数据库成立到2017年9月。所有研究报告了预测RRT开始的生物标志物的曲线下面积(AUC)。

六十三项研究包含了15928名危重病人(平均每项研究122.5人(31-1439))符合资格。四十一项研究评估了13种不同的生物标志物。这些生物标志物,如NGAL蛋白(NGAL)具有最多的证据。血液和尿液中NGAL合并的AUC分别为0.720(95%CI为0.638–0.803)和0.755(0.706–0.803)。血肌酐、胱抑素C合并的AUC分别为0.764(0.732–0.796)和0.768(0.729–0.807)。尿生物标记物、白细胞介素-18、胱抑素C、基质金属蛋白酶-2组织抑制剂的产物以及胰岛素样生长因子结合蛋白7显示汇总的AUC分别为0.668(0.606–0.729)、0.722(0.575–0.868)和0.857(0.789–0.925)。

由此可见,虽然一些生物标志物表明AKI的危重患者对RRT使用具有有前景和合理的预测,但目前的证据强度无法用于常规指导决策在何时开始RRT治疗。

原始出处:

Sebastian J. Klein, et al. Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis.Intensive Care Medicine.2018. http://icmjournal.esicm.org/journals/abstract.html?v=0&j=134&i=0&a=5126_10.1007_s00134-018-5126-8&doi=

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    2019-07-18 litao810414

    好文章,开拓视野

    0

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createdTime=Wed Mar 21 22:44:00 CST 2018, time=2018-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298348, encodeId=c4c02983480e, content=学习了.获益匪浅.感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/27/c53a212859edcad4f60a54feffff50bb.jpg, createdBy=67cf1525321, createdName=13718711b3m, createdTime=Wed Mar 21 13:16:22 CST 2018, time=2018-03-21, status=1, ipAttribution=)]
  5. 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createdTime=Wed Mar 21 22:44:00 CST 2018, time=2018-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298348, encodeId=c4c02983480e, content=学习了.获益匪浅.感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/27/c53a212859edcad4f60a54feffff50bb.jpg, createdBy=67cf1525321, createdName=13718711b3m, createdTime=Wed Mar 21 13:16:22 CST 2018, time=2018-03-21, status=1, ipAttribution=)]
  6. 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  7. 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  8. 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  9. 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  10. 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createdTime=Wed Mar 21 22:44:00 CST 2018, time=2018-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298348, encodeId=c4c02983480e, content=学习了.获益匪浅.感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/27/c53a212859edcad4f60a54feffff50bb.jpg, createdBy=67cf1525321, createdName=13718711b3m, createdTime=Wed Mar 21 13:16:22 CST 2018, time=2018-03-21, status=1, ipAttribution=)]
    2018-03-21 13718711b3m

    学习了.获益匪浅.感谢分享

    0

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由此可见,目前在进行口服抗凝治疗决策时所采用的风险评分对未选择的房颤患者的长期生存率提供了较好的预测,尤其是门诊患者。

JCEM:Proneurotensin预测老年人心血管疾病!

由此可见,在老年人群中,proneurotensin可独立预测男性和女性个体心血管疾病的发展,而只能预测女性糖尿病的发生发展。

SCI REP:术前改良体重指数对术后1年死亡率的预测价值!

由此可见,低白蛋白是术后1年死亡率三个变量重最强的独立预测因子(白蛋白、cBMI和mBMI)。将cBMI加入到白蛋白中并不能增加白蛋白AUC的有效性。