Lub luag haujlwm ntawm Urinary raum Stress Biomarkers Rau Kev Paub Txog Thaum Ntxov Ntawm Subclinical Acute raum Injury hauv Critically Ill COVID-19 Cov Neeg Mob

3. Cov txiaj ntsig

3.1. Cov yam ntxwv ntawm Kev Kawm Cov Neeg

Lub sijhawm nruab nrab ntawm lub Tsib Hlis thiab Lub Yim Hli 2020, tag nrho ntawm 420 tus neeg tau txais mus rau thaj chaw tseem ceeb ntawm INER. Ntawm cov ntawd, 69 qhov tsis zoo rau SARS-CoV-2 kab mob; hauv 44 tus kab mob tsis tuaj yeem paub meej; 60 tseem nyob hauv chav xwm txheej ceev vim yog tsev kho mob saturation; thiab 20 tuag nyob ntawd. Kev tso cai tsis tuaj yeem tau txais rau 196 tus neeg mob. Yog li peb suav nrog 51 tus neeg mob uas tau lees paub kev pom zoo rau kev koom nrog hauv txoj kev tshawb no (Daim duab 1). Ntawm cov, 30 yog txiv neej (58.8%); hnub nyoog nruab nrab yog 53 xyoo (IQR: 40–61); 14 muaj ntshav siab (27.5%); 16 muaj ntshav qab zib (31.4%); thiab 21 yog rog 41.2%. Ntawm 51 tus neeg uas tau kawm, 25 tau tsim AKI thaum mus pw hauv tsev kho mob (cov pab pawg AKI, 49.0%) thiab 26 tsis tsim AKI (cov pab pawg tsis yog AKI, 51.0%). Tag nrho ntawm 11 tus neeg muaj AKI theem 1 (21.5%); 8 muaj AKI theem 2 (15.6%); thiab 6 muaj AKI theem 3 (11.7%). Cov yam ntxwv tseem ceeb ntawm kev kawm cov pej xeem thiab kev sib piv ntawm pawg AKI vs. cov pab pawg tsis-AKI tau qhia hauv Table 1.

Daim duab 1. Daim duab qhia kev kawm. Cov naj npawb ntawm cov tib neeg uas raug soj ntsuam rau kev tsim nyog thiab cov tib neeg uas tau suav nrog hauv txoj kev tshawb fawb

3.2. Kev ua tau zoo ntawm Biomarkers raws li AKI Predictors

Raws li qhov siab tshaj AUC, qhov tshwj xeeb, thiab qhov tseeb qhov tseem ceeb, biomarker nrog kev ua tau zoo tshaj plaws rau AKI kev kwv yees thaum lub sij hawm tag nrho hauv tsev kho mob yog NGAL ntawm kev txiav tawm ntawm 45 ng / mL. Xav txog tias cov neeg mob feem ntau tsim AKI thaum thawj 7 hnub hauv tsev kho mob, peb kuj tau txiav txim siab qhov ua tau zoo ntawm biomarkers rau AKI kwv yees hnub 7 (Table 2). Kev ua tau zoo ntawm NGAL tau zoo dua nyob rau hnub 7 dua li lub sijhawm pw hauv tsev kho mob tag nrho (AUC=0.771 vs. AUC=0.706; p=0.001 ). Kev sib xyaw ua ke ntawm [TIMP-2] × [IGFBP7] ntawm kev txiav tawm ntawm 0.2 (ng / mL) 2/1000 yog qhov thib ob zoo tshaj plaws AKI kwv yees, thiab kev ua tau zoo ntawm cov biomarkers thaum lub sij hawm tag nrho hauv tsev kho mob zoo ib yam li ntawm day 7 (AUC= 0.682 vs. AUC= 0.671; p=0.632).

Table 1. Cov yam ntxwv tseem ceeb ntawm cov neeg kawm

AKI,mob raum mob; BMI,lub cev index; IMV, invasive mechanical qhov cua; PaO2 / FiO2, ib nrab arterial oxygen siab / inspired oxygen feem; pCO2, ib nrab siab ntawm carbon dioxide; PEEP, qhov zoo kawg nkaus-kawg siab; SOFA, kev ntsuam xyuas lub cev tsis ua haujlwm; eGFR, kwv yees glomerular pom tus nqi; Cov tshuaj steroids: dexamethasone, methylprednisolone; prednisone; NGAL, neutrophil gelatinase-associated lipocalin; TIMP-2, cov ntaub so ntswg inhibitor ntawm metalloproteinases 2; IGFBP7, insulin-zoo li kev loj hlob zoo li kev khi cov protein 7. * Cov ntaub ntawv qhia tau hais tias yog qhov nruab nrab (interquartile ranges). Kev sib piv ntawm pawg AKI vs. cov pab pawg uas tsis yog-AKI tau tsim los siv chi-squared test rau categorical variables thiab Mann-Whitney U rau qhov sib txawv tsis tu ncua. Bold qhov tseem ceeb qhia txog qhov tseem ceeb ntawm qhov p Tsawg dua lossis sib npaug rau 0.05 qib.

Table 2. Kev ua tau zoo ntawm urinary biomarkers rau kev kwv yees ntawm mob raum raug mob nyob rau hauv cov neeg mob hnyav COVID-19.

AKI, mob raum raug mob; AUC, cheeb tsam nyob rau hauv lub receiver-operating yam ntxwv nkhaus; CI, kev ntseeg siab luv; PPV, zoo kwv yees tus nqi; NPV, tus nqi kwv yees tsis zoo; NGAL; neutrophil gelatinase-kwv yees li lipocalin; TIMP-2, cov ntaub so ntswg inhibitor ntawm metalloproteinases-2; IGFBP7, insulin-zoo li kev loj hlob zoo li kev khi cov protein 7.

3.3. Lub sij hawm rau AKI tau luv luv luv rau cov tib neeg uas muaj txiaj ntsig ntau dua ntawm cov zis NGAL thiab [TIMP-2] × [IGFBP7]

Raws li NGAL 45 ng / mL muaj qhov tshwj xeeb tshaj plaws thiab qhov tseeb qhov tseem ceeb, peb tau xaiv qhov kev txiav tawm no rau kev ntsuas kev muaj sia nyob ntawm lub sijhawm rau AKI thaum mus pw hauv tsev kho mob. Cov tib neeg uas muaj NGAL Ntau dua lossis sib npaug li 45 ng / mL tau muab piv rau cov uas muaj<45 ng/mL. Urinary NGAL could not be measured in 3 patients. The time to AKI was significantly shorter in individuals with NGAL ≥ 45 ng/mL than in those with <45 ng/mL; p = 0.028 (Figure 2). Similarly, [TIMP-2] × [IGFBP7] 0.2 (ng/mL)2/1000 had the highest specificity and accuracy, so this cutoff was selected for the survival analysis of the time to AKI during hospitalization. We found that the time to AKI was significantly shorter in individuals with [TIMP-2] × [IGFBP7] ≥ 0.2 ng/mL than in those with <0.2 (ng/mL)2/1000; p = 0.017 (Figure 3).

3.4. Cov txiaj ntsig siab ntawm cov zis [TIMP-2] × [IGFBP7] yog qhov pheej hmoo rau AKI

Qhov kev tshuaj ntsuam tsis sib xws tau qhia tias cov neeg mob AKI laus dua (kev phom sij, HR {{0}}}.94, 95% CI: 0.9{{20}}-{ {61}}.99; p=0.034); muaj ntau zaus ntawm kev kub siab (HR=6.02, 95% CI: 1.42–25.40; p=0.014); muaj qib [TIMP-2] × [IGFBP7] Ntau dua lossis sib npaug rau 0.2 (ng/mL)2/1000 (HR=5.11, 95% CI: 1.20 -21.67; p=0.027; thiab NGAL Ntau dua lossis sib npaug li 45 ng/mL (HR=4.00, 95% CI: 1.15–13.81; p=0.028). Tom qab hloov kho rau qhov sib txawv ntawm qhov ua tau tsis txaus ntseeg, kev tshuaj xyuas ntau yam qhia tau hais tias muaj feem cuam tshuam rau AKI thaum lub sijhawm pw hauv tsev kho mob yog txiv neej poj niam txiv neej (HR=7.57, 95% CI: 1.28–44.8; p=0.026 ) thiab [TIMP-2] × [IGFBP7] Ntau dua lossis sib npaug li 0.2 (ng/mL)2/ 1000 (HR=7.23, 95% CI: 0.99–52.4; p {{65} }}.050) (Table 3). Hnub 7 ntawm kev mus pw hauv tsev kho mob, tom qab hloov kho raws hnub nyoog thiab poj niam txiv neej, peb pom tias tsuas yog [TIMP-2] × [IGFBP7] Ntau dua lossis sib npaug rau 0.2 (ng / mL) 2/1000 tseem cuam tshuam nrog kev pheej hmoo rau AKI ( HR=5.91, 95% CI: 1.06–32.7 p=0.042).

3.5. Kev tuag tau siab dua hauv cov tib neeg nrog AKI

Peb tsim lub Kaplan-Meyer nkhaus rau kev tuag piv rau pawg ntawm 25 tus neeg mob uas tsimAKIthaum taug qab nrog pab pawg ntawm 26 tus neeg tsis muaj AKI. Kev tuag ntawm cov tib neeg uas tsim AKI txhua lub sijhawm thaum mus pw hauv tsev kho mob tau ntau dua li cov neeg uas tsis tau muaj AKI, p=0.019 (Daim duab 4).

Daim duab 2. Cuam tshuam AKI cov xwm txheej raws li cov zis NGAL concentrations. AKI hauv cov neeg uas tso zis NGAL > 45 ng/mL (rov kab) vs. AKI hauv cov neeg uas muaj zis NGAL < 45 ng/mL ( kab grey) thaum mus pw hauv tsev kho mob (p=0.028). Sijhawm 0 sib raug rau kev nkag mus hauv tsev kho mob.

Table 3. Cov xwm txheej txaus ntshai rau mob raum raug mob hauv cov neeg mob COVID-19 hnyav heev.

HR, txaus ntshai piv; CI, kev ntseeg siab luv; NGAL; neutrophil gelatinase-kwv yees li lipocalin; TIMP-2, cov ntaub so ntswg inhibitor ntawm metalloproteinases 2; IGFBP7, zoo li insulin-zoo li kev loj hlob ntawm cov protein 7; CPK, creatine phosphoki nase. Cov kev hloov pauv tau nkag mus rau hauv tus qauv thaum qib alpha ntawm kev pheej hmoo tsawg dua 0.15. Hnub nyoog thiab poj niam txiv neej tau ntxiv rau hauv tus qauv tsis hais qib alpha. Bold qhov tseem ceeb qhia txog qhov tseem ceeb ntawm qhov p Tsawg dua lossis sib npaug rau 0.05 qib.

Daim duab 3. Cuam tshuam AKI cov xwm txheej raws li tso zis [TIMP-2] × [IGFBP7] concentrations. AKI hauv cov neeg uas tso zis [TIMP-2] × [IGFBP7] > 0.2 (ng/mL)2/1000 (kab dub) vs. AKI hauv cov neeg uas tso zis [TIMP-2] × [IGFBP7] < 0.2 (ng/mL)2/1000 (grey kab) thaum mus pw hauv tsev kho mob (p=0.013). Sijhawm 0 sib raug rau kev nkag mus hauv tsev kho mob.

Ntawm 25 tus neeg uas muaj AKI, 13 muaj AKI ncua sij hawm (25.5%) thiab 12 muaj mob AKI (23.5%). CKD-EPI ntawm kev tso tawm tau zoo sib xws hauv cov neeg uas muaj AKI tsis tu ncua (79.5 mL / min / 1.73m2, IQR: 17-111) thiab hauv cov neeg uas muaj AKI (93 mL / min / 1.73m2, IQR: 88-104; p.=0.53). Logistic regression tsom xam tau siv los txheeb xyuas qhov kev sib koom ua ke ntawm cov kev sib raug zoo nrog kev tuag. Qhov kev tshuaj ntsuam univariate qhia tias kev tuag ntau zaus hauv cov neeg mob uas muaj hnub nyoog 60 xyoo lossis laus dua (HR=5.33, 95% CI: 1.23–23.09; p=0.025); thiab muaj AKI (HR=10.83, 95% CI: 1.67–69.91; p=0.012). Tom qab hloov kho rau qhov kev hloov pauv tsis txaus ntseeg, tsuas yog AKI tsis tu ncua tseem cuam tshuam nrog kev tuag (HR=7.42, 95% CI: 1.04–53.04; p=0.046) (Table 4).