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Objective To explore the value of plasma soluble urokinase-type plasminogen activator receptor (suPAR),urinary neutrophil gelatinase associated apolipoprotein (NGAL) and urinary kidney injury molecule-1 (KIM-1) in the early diagnosis of adult with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods A prospective case-control study was conducted with consecutively recruited 170 patients undergoing cardiac surgery with cardiopulmonary bypass in the Department of Cardiac Surgery, the First Affiliated Hospital of Army Medical University from March 2020 to February 2021. Venous blood and urine were collected before operation, 2 hours, 2 days and 7 days after operation, and the levels of plasma suPAR, urine NGAL and urine KIM-1 were detected by enzyme linked immunosobent assay (ELISA). According to the occurrence of AKI 7 days after operation, the patients were divided into AKI group (n=34) and non-AKI group (n=136). The levels of plasma suPAR, urinary NGAL and urinary KIM-1 were compared between the two groups. The risk factors of CSA-AKI were analyzed by logistic regression,and the value of plasma suPAR, urine NGAL and KIM-1 for the early diagnosis of CSA-AKI was evaluated by receiver operating characteristic (ROC) curve. Results The level of plasma suPAR was significantly higher in AKI group than that in non-AKI group(P<0.01). The levels of urinary KIM-1 at 2 h after operation and urinary NGAL at 2 h and 7 d after operation were significantly higher in AKI group than those in non-AKI group (P<0.05). ROC analysis showed that the area under curve (AUC) of preoperative plasma suPAR, postoperative 2 h plasma suPAR, urine Kim-1 and urine NGAL diagnosed CSA-AKI were 0.683, 0.717, 0.643 and 0.631, respectively. The AUC area which combined detection of postoperative 2 h plasma suPAR + postoperative 2 h urine KIM-1+ 2 h urine NGAL was the largest (AUC=0.793, 95%CI 0.708-0.879, P<0.001), and the sensitivity and the specificity were 64.71%and 82.35%. Logistic regression analysis showed that after adjusting for sex, preoperative left ventricular ejection fraction (LVEF),albumin (ALB), postoperative 2 h creatinine, postoperative 2 h estimated glomerular filtration rate (eGFR), postoperative 2 h blood urea nitrogen (BUN), postoperative 2 h KIM-1 and postoperative 2 h NGAL, postoperative 2 h suPAR was still an independent risk factor for CSA-AKI. Conclusion Plasma suPAR, urine NGAL and urine Kim-1 can be used for early diagnosis of CSA-AKI.The diagnostic efficacy of plasma suPAR at 2 hours after operation is the best when detected alone. Combined detection of plasma suPAR, urine NGAL and urine Kim-1 at 2 hours after operation can further improve the diagnostic efficiency of CSA-AKI.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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