急性肾损伤
医学
危险系数
内科学
生物标志物
来复枪
急性肾小管坏死
肾
生物化学
置信区间
历史
考古
化学
作者
George Vasquez-Rios,Won-Suk Oh,Samuel Lee,Pavan K. Bhatraju,Sherry G. Mansour,Dennis G. Moledina,Faris F Gulamali,Edward D. Siew,Amit X. Garg,Pinaki Sarder,Vernon M. Chinchilli,James S. Kaufman,Chi-yuan Hsu,Kathleen D. Liu,Paul L. Kimmel,Alan S. Go,Mark M. Wurfel,Jonathan Himmelfarb,Chirag R. Parikh,Steven G. Coca,Girish N. Nadkarni
出处
期刊:Clinical Journal of The American Society of Nephrology
[American Society of Nephrology]
日期:2023-03-28
卷期号:18 (6): 716-726
被引量:3
标识
DOI:10.2215/cjn.0000000000000156
摘要
Background AKI is a heterogeneous syndrome. Current subphenotyping approaches have only used limited laboratory data to understand a much more complex condition. Methods We focused on patients with AKI from the Assessment, Serial Evaluation, and Subsequent Sequelae in AKI (ASSESS-AKI). We used hierarchical clustering with Ward linkage on biomarkers of inflammation, injury, and repair/health. We then evaluated clinical differences between subphenotypes and examined their associations with cardiorenal events and death using Cox proportional hazard models. Results We included 748 patients with AKI: 543 (73%) of them had AKI stage 1, 112 (15%) had AKI stage 2, and 93 (12%) had AKI stage 3. The mean age (±SD) was 64 (13) years; 508 (68%) were men; and the median follow-up was 4.7 (Q1: 2.9, Q3: 5.7) years. Patients with AKI subphenotype 1 ( N =181) had the highest kidney injury molecule (KIM-1) and troponin T levels. Subphenotype 2 ( N =250) had the highest levels of uromodulin. AKI subphenotype 3 ( N =159) comprised patients with markedly high pro–brain natriuretic peptide and plasma tumor necrosis factor receptor-1 and -2 and low concentrations of KIM-1 and neutrophil gelatinase–associated lipocalin. Finally, patients with subphenotype 4 ( N =158) predominantly had sepsis-AKI and the highest levels of vascular/kidney inflammation (YKL-40, MCP-1) and injury (neutrophil gelatinase–associated lipocalin, KIM-1). AKI subphenotypes 3 and 4 were independently associated with a higher risk of death compared with subphenotype 2 and had adjusted hazard ratios of 2.9 (95% confidence interval, 1.8 to 4.6) and 1.6 (95% confidence interval, 1.01 to 2.6, P = 0.04), respectively. Subphenotype 3 was also independently associated with a three-fold risk of CKD and cardiovascular events. Conclusions We discovered four AKI subphenotypes with differing clinical features and biomarker profiles that are associated with longitudinal clinical outcomes.
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