Background

Though significant progress has been made towards new diagnostic approaches for early detection of acute kidney injury (AKI) induced by different factors, there is still an urgent demand for a more specific and predictive biomarker for each type. The aim of this study is to unravel the potential diagnostic utility of circulating osteoprotegerin (OPG) in septic patients who developed AKI in the ICU, compared to cystatin C (a renal function maker) and KIM-1 (a kidney damage marker).

Methods

Eighty patients (male = 43, female = 37) with ages ranging from 42 to 46 years and with sepsis, 40 of whom developed AKI, and 30 healthy controls were enrolled in this prospective study.

Results

Results revealed significant progressive elevation of OPG, along with cystatinCand KIM-1, among sepsis, severe sepsis, and sepsis-AKI patients. The progression of OPG levels paralleled the deterioration of kidney and endothelial functions from sepsis to sepsis-AKI, revealed as progressively increased levels of serum Eselectin (15.3%), endothelin-1 (ET-1) (19.6%), and decreased nitric oxide (NO) (29.7%), associated with elevations of TNF-α (25.5%) and TGF-β (18%). Their comparative prognostic validity of sepsis-AKI was assessed using ROC analysis, which revealed that OPG, KIM-1, and cystatin C showed similar AUCs (0.827-0.83) but with different sensitivities, viz., 84%, 88%, and 92%, respectively. Although cystatin showed 82% specificity, OPG showed a higher, similar specificity to KIM-1 of 85%, indicating its potential function as a marker of renal damage such as KIM-1.

Conclusion

This study revealed a significant elevation of circulating OPG in septic patients with different levels of severity and those who progressed to AKI. Moreover, OPG showed a significant correlation to KIM-1 and cystatin, as well as conventional renal, inflammatory, and endothelial markers. Having a similar specificity to KIM-1, as evidenced by the ROC analysis, OPG has the potential to serve as a reliable biomarker of kidney damage in cases of sepsis-AKI.

中文翻译：

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循环骨保护素作为新型生物标志物的预测能力，可用于早期检测败血症引起的急性肾损伤。

背景

尽管在早期诊断由不同因素引起的急性肾损伤（AKI）的新诊断方法方面已经取得了重大进展，但仍然迫切需要针对每种类型的更特异性和可预测性的生物标记物。与半胱氨酸蛋白酶抑制剂C（肾功能制造者）和KIM-1（肾损害标志物）相比，本研究的目的是揭示循环骨保护素（OPG）在ICU中发展为AKI的败血症患者的潜在诊断作用。

方法

这项前瞻性研究纳入了80位年龄在42至46岁之间且患有败血症的患者（男性= 43，女性= 37），其中40例患有AKI，另外30例健康对照者。

结果

结果显示，脓毒症，严重脓毒症和脓毒症-AKI患者中OPG以及cystatinC和KIM-1明显升高。从脓毒症到脓毒症-AKI，OPG水平的升高与肾脏和内皮功能的恶化平行，表现为血清Eselectin（15.3％），内皮素-1（ET-1）（19.6％）的水平逐渐升高，而一氧化氮水平降低（NO）（29.7％），与TNF-α（25.5％）和TGF-β（18％）升高相关。使用ROC分析评估了败血症AKI的相对预后有效性，该结果显示OPG，KIM-1和胱抑素C显示相似的AUC（0.827-0.83），但敏感性不同，分别为84％，88％和92 ％， 分别。尽管半胱氨酸蛋白酶抑制剂显示出82％的特异性，但OPG的特异性更高，与KIM-1相似，为85％，

结论

这项研究表明，在严重程度不同的脓毒症患者和进展为AKI的脓毒症患者中，循环OPG显着升高。此外，OPG与KIM-1和cystatin以及常规的肾脏，炎症和内皮标记物之间具有显着相关性。正如ROC分析所证明的，OPG具有与KIM-1相似的特异性，在脓毒症-AKI病例中，OPG有潜力作为可靠的肾脏损害生物标志物。