BACKGROUND & AIMS:
OBJECTIVE:To assess the role of insulin-like growth factor-1 and cholesterol as predictors of acute kidney injury mortality in intensive care unit patients.
DESIGN:Prospective cohort study.
SETTING:Multidisciplinary adult intensive care unit (24 beds).
PATIENTS:Adult patients with acute kidney injury at intensive care unit admission for an 11-month period were considered and a total of 56 patients were admitted in the study.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:At intensive care unit admission serum insulin-like growth factor-1 (ng/mL), total cholesterol (mg/dL), albumin (g/dL), transferrin (mg/dL), total lymphocyte count, triceps skinfold thickness, arm muscle area, and Subjective Global Nutritional Assessment were evaluated. Insulin-like growth factor-1 was significantly lower in nonsurviving as compared with surviving patients (48.5 +/- 24.4 vs. 70.8 +/- 39.9; p = 0.044), as well as cholesterol (80.3 +/- 35.7 vs. 147.4 +/- 53.1; p < 0.001) and albumin (1.9 +/- 0.4 vs. 2.4 +/- 0.7; p = 0.018). Groups were similar regarding transferrin, lymphocyte, triceps skinfold thickness, arm muscle area, and subjective global nutritional assessment. A binary logistic regression model based on insulin-like growth factor-1 < or = median (50.6 ng/mL), presence of sepsis, oliguria, and cholesterol < or = median (96 mg/dL) identified insulin-like growth factor-1 (odds ratio = 7.73; 95% confidence interval 1.19-49.87; p = 0.032), sepsis (odds ratio = 7.28; 95% confidence interval 1.29-40.89; p = 0.024), oliguria (odds ratio = 8.7; 95% confidence interval 1.10-68.77; p = 0.040) and cholesterol (odds ratio = 10.94; 95% confidence interval 1.89-63.29; p = 0.008) as independent covariate for death.
CONCLUSIONS:Decreased levels of insulin-like growth factor-1 and cholesterol were clearly related to higher mortality. The close correlation of insulin-like growth factor-1 with nutritional status, its serum stability, and short-half life makes it a suitable candidate for an early and sensitive marker for intensive care unit acute kidney injury mortality.
背景与目标:
目标 strong>:评估胰岛素样生长因子-1和胆固醇在重症监护病房患者急性肾损伤死亡率预测中的作用。
DESIGN strong> :前瞻性队列研究。
设置 strong>:多学科成人加护病房(24张床)。
患者 strong>:成年急性肾病患者在研究中考虑了重症监护病房入院11个月期间的受伤情况,共有56名患者入院。
干预措施 strong>:无。
< strong>措施和主要结果 strong>:重症监护病房入院时,血清胰岛素样生长因子-1(ng / mL),总胆固醇(mg / dL),白蛋白(g / dL),转铁蛋白(mg / dL) ),总淋巴细胞计数,三头肌皮褶厚度,手臂肌肉区域和主观全球营养评估进行了评估。与未存活患者相比,未存活患者的胰岛素样生长因子-1明显更低(48.5 /-24.4 vs. 70.8 /-39.9; p = 0.044)以及胆固醇(80.3 /-35.7 vs. 147.4 /-53.1;以及p <0.001)和白蛋白(1.9 /-0.4 vs. 2.4 /-0.7; p = 0.018)。在转铁蛋白,淋巴细胞,肱三头肌皮褶厚度,手臂肌肉面积和主观总体营养评估方面,各组相似。基于胰岛素样生长因子-1 <或=中位数(50.6 ng / mL),败血症,少尿和胆固醇<或=中位数(96 mg / dL)的二元logistic回归模型确定了胰岛素样生长因子- 1(赔率= 7.73; 95%置信区间1.19-49.87; p = 0.032),败血症(赔率= 7.28; 95%置信区间1.29-40.89; p = 0.024),少尿(赔率= 8.7; 95%置信度
结论 strong>:区间为1.10-68.77; p = 0.040)和胆固醇(优势比= 10.94; 95%置信区间1.89-63.29; p = 0.008)。胰岛素样生长因子-1和胆固醇水平的降低显然与更高的死亡率有关。胰岛素样生长因子-1与营养状况,血清稳定性和半衰期密切相关,使其成为重症监护病房急性肾损伤死亡率的早期敏感标记物的合适候选者。