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Writing prescriptions

机译：书写处方

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Background: The accurate prediction of acute kidney injury (AKI) is an unmet clinical need. A combined assessment of cardiac stress and renal tubular damage might improve early AKI detection. Methods: A total of 372 consecutive patients presenting to the Emergency Department with lower respiratory tract infections were enrolled. Plasma B-type natriuretic peptide (BNP) and neutrophil gelatinase-associated lipocalin (NGAL) levels were measured in a blinded fashion at presentation. The potential of these biomarkers to predict AKI was assessed as the primary endpoint. AKI was defined according to the AKI Network classification. Results: Overall, 16 patients (4%) experienced early AKI. These patients were more likely to suffer from preexisting chronic cardiac disease or diabetes mellitus. At presentation, BNP (334 pg/mL [130-1119] vs 113 pg/mL [52-328], P <.01) and NGAL (269 ng/mL [119-398] vs 96 ng/mL [60-199], P <.01) levels were significantly higher in AKI patients. The predictive accuracy of presentation BNP and NGAL levels was comparable (BNP 0.74; 95% confidence interval [CI], 0.64-0.84 vs NGAL 0.74; 95% CI, 0.61-0.87). In a combined logistic model, a joint BNP/NGAL approach improved the predictive accuracy for early AKI over either biomarker alone (area under the receiver operating characteristic curve: 0.82; 95% CI, 0.74-0.89). The combined categorical cut point defined by BNP >267 pg/mL or NGAL >231 ng/mL correctly identified 15 of 16 early AKI patients (sensitivity 94%, specificity 61%). During multivariable regression analysis, the combined BNP/NGAL cutoff remained the independent predictor of early AKI (hazard ratio 10.82; 95% CI, 1.22-96.23; P =.03). Conclusion: A model combining the markers BNP and NGAL is a powerful predictor of early AKI in patients with lower respiratory tract infection.
机译：背景：急性肾损伤（AKI）的准确预测是尚未满足的临床需求。对心脏压力和肾小管损伤的综合评估可能会改善AKI的早期发现。方法：共有372名连续出现在急诊科的下呼吸道感染患者。呈示时以盲法测量血浆B型利钠肽（BNP）和中性粒细胞明胶酶相关的脂钙素（NGAL）的水平。这些生物标志物预测AKI的潜力被评估为主要终点。 AKI是根据AKI网络分类定义的。结果：共有16例患者（4％）经历了早期AKI。这些患者更容易患慢性心脏病或糖尿病。在介绍时，BNP（334 pg / mL [130-1119]对113 pg / mL [52-328]，P <.01）和NGAL（269 ng / mL [119-398]对96 ng / mL [60- 199]，P <.01）水平在AKI患者中明显更高。表现BNP和NGAL水平的预测准确性相当（BNP 0.74; 95％置信区间[CI]为0.64-0.84，而NGAL 0.74; 95％CI为0.61-0.87）。在联合逻辑模型中，联合的BNP / NGAL方法相对于单独使用任一生物标记物（接受者工作特征曲线下的面积：0.82; 95％CI，0.74-0.89）提高了早期AKI的预测准确性。由BNP> 267 pg / mL或NGAL> 231 ng / mL定义的组合分类切点正确识别了16例早期AKI患者中的15例（敏感性94％，特异性61％）。在多变量回归分析中，合并的BNP / NGAL截止值仍然是早期AKI的独立预测因子（危险比10.82; 95％CI为1.22-96.23; P = .03）。结论：结合BNP和NGAL标记的模型是下呼吸道感染患者早期AKI的有力预测指标。

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