尿微量白蛋白／尿肌酐比值预测重症患者急性肾损伤及预后的临床价值

Clinical value of urine albumin/creatinine ratio in predicting diagnosis and prognosis of actue kidney injury in critically ill patients

目的探讨尿微量白蛋白与尿肌酐比值（albumin/creatinine ratio，UACR）在预测重症患者急性肾损伤（acute kidney injury，AKI）诊断及预后的临床价值。方法前瞻性入选2014年10月至2015年5月入住广东省3家医院重症医学科（intensive care unit，ICU）的重症患者527例。按2012年改善全球肾脏病预后组织（Kidney Disease：Improving Global Outcomes, KDIGO）标准，将患者分为AKI组和非AKI组，其中AKI组又分为轻症（KDIGO标准1期）及重症（KDIGO标准2、3期），分别检测并比较各组UACR指标水平，使用受试者工作特征（receiver operating characteristic curve，ROC）曲线及其曲线下面积（area under cruve，AUC）评价UACR在AKI诊断、进展及预后的临床价值，以P〈0.05为差异具有统计学意义。结果（1）527例重症患者中有148例发生AKI，发生率为28.1%。AKI组患者UACR明显高于非AKI患者（P〈0.05）。（2）54例患者发展成重症AKI（10.2%），重症AKI组UACR显著高于非AKI组及轻症AKI组（P〈0.05）。（3）UACR预测AKI及重症AKI的AUC分别为0.706，0.748，具有中度以上预测能力。（4）UACR预测入ICU时AKI、入ICU后7 d内发生AKI、进展性AKI的AUC分别为0.702、0.675、0.649；预测ICU内肾脏替代治疗、ICU病死率、住院病死率的AUC是0.851、0.781、0.748。结论UACR可预测重症患者AKI及其预后，是AKI早期诊断及预后评估的生物标志物。

ObjectiveTo explore the clinical value of urine albumin/creatinine ratio（UACR）in predicting diagnosis and prognosis of acute kidney injury （AKI） in adult critically ill patients.MethodsA total of 527 adult critically ill patients admitted to the adult mixed ICU of three hospitals in Guangdong Province were prospectively enrolled from October 2014 to May 2015. According to the Kidney Disease Improving Global Outcomes（KDIGO）criterion, the patients were divided into non-AKI group and AKI group （including mild AKI and severe AKI）. The biomarker＇s capability of detecting AKI and its prognosis were evaluated by using the receiver operating characteristic curve（ROC） and the area under curve（AUC）. A P〈0.05 was considered to indicate statistical significance.ResultsThere were 148 AKI patients （28.1%）. The level of UACR was significantly higher in AKI than that in non-AKI （P〈0.05）. In total, there were 54 patients（10.2%）developed into severe AKI.The level of UACR was significantly higher in severe AKI than that in non-AKI and mild AKI （P〈0.05）. The AUC of UACR predicted AKI and severe AKI after ICU admission were 0.706 and 0.748, respectively with moderate predictive capability. The AUC of UACR for established AKI, later-onset AKI and AKI progression were 0.702, 0.675, 0.649, respectively. AUC of UACR for required dialysis, in-ICU mortality and in-hospital mortality prediction were 0.851, 0.781, 0.748, respectively.ConclusionsUACR has capability in predict diagnosis and prognosis of AKI in adult critically ill patients, and it is the biomarker for early diagnosis and prognosis evaluation of AKI.