血清NT-proBNP浓度对新生儿心脏手术后AKI的预测价值:基于pROCK标准

Predictive value of serum N-terminal pro-B-type natriuretic peptide concentration for postoperative acute kidney injury in neonates undergoing cardiac surgery:based on pROCK criteria

目的评价血清N末端B型利钠肽前体(NT-proBNP)浓度对新生儿心脏手术后急性肾损伤(AKI)的预测价值。方法回顾性收集2017年10月至2021年5月在本院行心脏手术的110例新生儿(出生≤28 d)的围术期资料。根据优化急性肾损伤儿科参考变化值(pROCK)标准分为AKI组和非AKI组。比较2组患儿人口统计学资料、主要诊断、实验室检查、围术期管理和术后结局等指标。血清NT-proBNP浓度为术后12 h内常规测定指标。采用多因素logistic回归模型析血清NT-proBNP浓度与术后AKI的关系。绘制受试者工作特征曲线,根据曲线下面积判断血清NT-proBNP浓度对术后AKI的预测价值。结果共纳入新生儿106例,术后AKI发生率54.7%。2组血红蛋白浓度、红细胞压积、血清肌酐浓度和血清NT-proBNP浓度比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示,血清NT-proBNP浓度升高是新生儿心脏手后AKI的独立危险因素(比值比2.49,95%可信区间1.18~5.23,P=0.016)。血清NT-proBNP浓度预测新生儿心脏手术后AKI的曲线下面积为0.66,其95%可信区间为0.55~0.76(P=0.007)。结论血清NT-proBNP浓度升高是新生儿心脏手术后AKI的独立危险因素,对AKI具有一定预测价值,密切监测围术期NT-proBNP水平有助于早期识别高风险患儿。

Objective To evaluate the predictive value of the serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)concentration for postoperative acute kidney injury(AKI)in neonates undergoing cardiac surgery.Methods Perioperative data of 110 consecutive neonates(≤28 days)who underwent cardiac surgery in our hospital from October 2017 to May 2021,were collected retrospectively.According to pROCK criteria,the patients were divided into AKI group and non-AKI group.Demographics,predominant diagnosis,laboratory examination,perioperative management and postoperative outcomes were compared between two groups.The concentration of serum NT-proBNP was routinely measured within 12 h after operation.Multivariate logistic regn*ssion analysis was perfornuMl for the association between serum NT-proBNP and postoperative AKI.Receiver operating characteristic cune was drawn,and the predictive value of serum NT-proBNP for postoperative AKI was determined according to the area under the c urve.Results A total of 106 neonates were enrolled,and the inc idence of postoperative AKI was 54.7%.1 here were significant diffemice in the baseline hemoglobin conctMitration,hematocrit and serum creatinine and serum NT-proBNP concentration hetwren AKI group and non-AKI group(P<0.05).Multi variate logistic regression analvsis indicated that NT-proBNP lenel was an independent risk factor for Akl after cardiac surgny in neonates(odds ratio 2.49,95%confidence interral 1.183-5.23,P=0.016).The area under the curve of NT-proBNP predicting AKI after cardiac surgery was 0.66(95%confidence interval 0.56-0.76,P-0.007).Conclusions Elevated serum NT-proBM)concentration is an independenl risk fac tor for AKI after cardiac surgery in neonates and lias a ccilain predictive value for AKI,and close monitoring of perioperative NT-proBNP level is helpful for early identification of higli-risk neonates.