尿钙卫蛋白预测外科重症监护室非心脏手术后严重急性肾损伤：一项前瞻性队列研究
Urinary Calprotectin Predicts Severe Acute Kidney Injury After Non-cardiac Surgery in Surgical Intensive Care Unit: A Prospective Cohort Study.
摘要(中文译文)
术后严重急性肾损伤（AKI）的风险分层有助于及时干预并改善预后。本研究旨在评估尿钙卫蛋白（calprotectin）对非心脏手术患者术后严重AKI风险分层的附加预测能力。共纳入580例患者，其中98例（17%）发生严重AKI，中位时间为入住外科重症监护病房（SICU）后12.8小时。在一项前瞻性队列中，纳入非心脏手术后转入SICU的患者，于入住SICU后0、6和12小时采集尿液样本并测定钙卫蛋白。建立预测严重AKI的临床模型。通过受试者工作特征曲线下面积（AUC）分析检验尿钙卫蛋白单独预测严重AKI的能力。我们进一步通过AUC的增量、相关综合判别改善指数（IDI）和净重分类改善指数（NRI）评估在临床模型中加入尿钙卫蛋白后预测能力的改善情况。严重AKI组在任何时间点的尿钙卫蛋白水平均较高（均P<0.001）。在整个队列中，入住SICU时尿钙卫蛋白预测严重AKI的AUC为0.701（95%CI，0.649～0.754），钙卫蛋白≥32.3 ng/ml与风险增加相关（OR 6.119，95%CI 3.259～11.488）。加入尿钙卫蛋白后，临床模型的AUC从0.693（95%CI，0.633～0.754）增至0.730（95%CI，0.677～0.784），NRI为0.337（P<0.001），IDI为0.055（P<0.001）。尿钙卫蛋白与临床特征相结合可能有助于非心脏手术患者术后严重AKI的风险分层。
Abstract
Postoperative risk stratification for severe acute kidney injury (AKI) can facilitate timely intervention and improve prognosis. This study aimed to evaluate the added predictive ability of urinary calprotectin for postoperative risk stratification of severe AKI in non-cardiac surgery patients. A total of 580 patients were enrolled, and 98 (17%) developed severe AKI with a median time of 12.8 hours after SICU admission. In a prospective cohort of patients transferred to the surgical intensive care unit (SICU) after non-cardiac surgery, calprotectin was measured in urine samples collected 0, 6, and 12 hours after SICU admission. A clinical model for predicting severe AKI was established. We tested the ability of urinary calprotectin alone to predict severe AKI by area under the receiver operating characteristics curve (AUC) analysis. We further evaluated the improvement of the pre-diction ability after adding urinary calprotectin in the clinical model by the increment in AUC, relevant integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Higher urinary calprotectin levels were observed in the severe AKI group at any time point (All P<0.001). In the entire cohort, the AUC of urinary calprotectin at SICU admission for predicting severe AKI was 0.701(95% CI, 0.649 to 0.754), and calprotectin ≥32.3 ng/ml was associated with increased risk (OR 6.119, 95% CI 3.259 - 11.488). The AUC of the clinical model increased from 0.693 (95%CI, 0.633 to 0.754) to 0.730 (95%CI, 0.677 to 0.784) upon adding urinary calprotectin, the NRI was 0.337 (P<0.001) and the IDI was 0.055 (P<0.001). A combination of urinary calprotectin and clinical features could be useful for postoperative risk stratification of severe AKI in non-cardiac surgery patients.
如何引用
AMA
Weijian Yao, Lingyi Xu, Nan Li, Jinwei Wang, Qingqing Zhou, Linger Tang, et al. Urinary Calprotectin Predicts Severe Acute Kidney Injury After Non-cardiac Surgery in Surgical Intensive Care Unit: A Prospective Cohort Study.. Biomarker insights. 2026; doi:10.1177/11772719261458627.
APA
Weijian Yao, Lingyi Xu, Nan Li, Jinwei Wang, Qingqing Zhou, Linger Tang, et al (2026). Urinary Calprotectin Predicts Severe Acute Kidney Injury After Non-cardiac Surgery in Surgical Intensive Care Unit: A Prospective Cohort Study.. Biomarker insights. https://doi.org/10.1177/11772719261458627
GB/T 7714
Weijian Yao, Lingyi Xu, Nan Li, Jinwei Wang, Qingqing Zhou, Linger Tang, et al. Urinary Calprotectin Predicts Severe Acute Kidney Injury After Non-cardiac Surgery in Surgical Intensive Care Unit: A Prospective Cohort Study.[J]. Biomarker insights, 2026 doi:10.1177/11772719261458627.
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