Clinical significance of renal biomarkers for early evaluation of acute kidney injury in sepsis

doi:10.3877/cma.j.issn.2096-1537.2019.02.010

Abstract

Abstract:

Objective

To evaluate the clinical significance of renal biomarkers for early evaluation of acute kidney injury (AKI) in sepsis.

Methods

This is a prospective case-control study of 60 patients with sepsis admitted to Affiliated Hospital of Nantong University. According to the diagnostic criteria of the Kidney Disease: Improving Global Outcomes (KDIGO), the patients were divided into either an AKI group or a non-AKI group. Urine volume, serum creatinine (SCr), blood urea nitrogen (BUN), blood β2 microglobulin, blood neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C, procalcitonin (PCT), amino terminal brain natriuretic peptide precursor (NT-proBNP), and urine protein were analyzed and compared between the two groups. The statistically significant factors in univariate analysis were further analyzed by multivariate logistic regression analysis. The accuracy of different indicators in predicting concurrent AKI in patients with sepsis was also evaluated.

Results

Urine volume, SCr, BUN, blood β2 microglobulin, blood NGAL, serum cystatin C, PCT, NT-proBNP and urine protein in the AKI group were significantly higher than those in the non-AKI group (t=1.754, P=0.021; t=-3.851, P<0.001; t=-4.972, P<0.001; t=-7.645, P<0.001; t=-3.451, P=0.001; t=-4.880, P<0.001; t=-3.231, P=0.002; t=-3.636, P=0.001; u=-2.775, P=0.006). Multivariate logistic regression analysis demonstrated that blood NGAL, serum cystatin C, and NT-proBNP were independent risk factors for AKI (P=0.015, 0.002, 0.023). The areas under the ROC curves of blood NGAL, serum cystatin C, and NT-proBNP were 0.840, 0.894, and 0.743, respectively.

Conclusion

Blood NGAL, serum cystatin C, and NT-proBNP are sensitive indicators for predicting AKI in patients with sepsis.

Key words: Sepsis, Acute kidney injury, Neutrophil gelatinase-associated lipocalin, Serum cystatin C, N terminal pro B type natriuretic peptide

Jiangsong Wu, Hongsheng Zhao, Xiaoli Cui. Clinical significance of renal biomarkers for early evaluation of acute kidney injury in sepsis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(02): 132-138.

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Figures/Tables 6

References 19

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指标	AKI组（29例）	非AKI组（31例）	统计值	P值
年龄（岁，±s）	68.0±12.9	69.4±13.1	t=0.424	0.673
性别（例，男性/女性）	20/9	17/14	χ²=1.265	0.261
SOFA评分（分，±s）	8.7±3.2	5.5±2.4	t=-4.431	<0.001
APACHE Ⅱ评分（分，±s）	20.9±8.2	13.2±5.1	t=-4.307	<0.001
WBC计数（×10⁹/L，±s）	13.3±10.1	12.0±6.7	t=-0.590	0.912
动脉血乳酸（mmol/L，±s）	3.4±2.5	2.0±1.4	t=-2.640	0.020
MBP（mmHg，±s）	79.2±13.9	85.1±15.6	t=1.523	0.132
应用血管活性药物［%（例/例）］	65.5（19/29）	48.4（15/31）	χ²=1.791	0.181
CRRT治疗［%（例/例）］	41.4（12/29）	3.2（1/31）	χ²=12.851	<0.001
感染性休克［%（例/例）］	65.5（19/29）	25.8（8/31）	χ²=9.547	0.002
机械通气［%（例/例）］	82.8（24/29）	90.3（28/31）	χ²=0.232	0.465
ICU住院时间（d，±s）	10.6±8.3	9.3±6.9	t=-0.644	0.525

指标	AKI组（29例）	非AKI组（31例）	统计值	P值
年龄（岁，±s）	68.0±12.9	69.4±13.1	t=0.424	0.673
性别（例，男性/女性）	20/9	17/14	χ²=1.265	0.261
SOFA评分（分，±s）	8.7±3.2	5.5±2.4	t=-4.431	<0.001
APACHE Ⅱ评分（分，±s）	20.9±8.2	13.2±5.1	t=-4.307	<0.001
WBC计数（×10⁹/L，±s）	13.3±10.1	12.0±6.7	t=-0.590	0.912
动脉血乳酸（mmol/L，±s）	3.4±2.5	2.0±1.4	t=-2.640	0.020
MBP（mmHg，±s）	79.2±13.9	85.1±15.6	t=1.523	0.132
应用血管活性药物［%（例/例）］	65.5（19/29）	48.4（15/31）	χ²=1.791	0.181
CRRT治疗［%（例/例）］	41.4（12/29）	3.2（1/31）	χ²=12.851	<0.001
感染性休克［%（例/例）］	65.5（19/29）	25.8（8/31）	χ²=9.547	0.002
机械通气［%（例/例）］	82.8（24/29）	90.3（28/31）	χ²=0.232	0.465
ICU住院时间（d，±s）	10.6±8.3	9.3±6.9	t=-0.644	0.525

肾脏相关指标		AKI组（29例）	非AKI组（31例）	统计值	P值
尿量（ml/h，±s）		63.0±45.6	82.1±38.7	t=1.754	0.021
血肌酐（μmol/L，±s）		185.7±168.4	64.4±21.2	t=-3.851	<0.001
血尿素氮（mmol/L，±s）		14.1±6.9	6.8±3.9	t=-4.972	<0.001
血β2微球蛋白（mg/L，±s）		6.9±3.1	2.4±0.8	t=-7.645	<0.001
血NGAL（μg/L，±s）		385.0±170.9	238.3±158.4	t=-3.451	0.001
血清胱抑素C（mg/L，±s）		2.0±1.2	0.9±0.4	t=-4.880	<0.001
PCT（μg/L，±s）		42.6±42.3	12.9±26.5	t=-3.231	0.002
NT-proBNP（ng/L，±s）		7149.4±8146.4	1579.2±1345.9	t=-3.636	0.001
尿蛋白（例）		?	?	u=-2.775	0.006
?	-	3	12	?	?
?	±	5	7	?	?
?	＋	13	8	?	?
?	＋＋	2	2	?	?
?	＋＋＋	6	2	?	?

肾脏相关指标		AKI组（29例）	非AKI组（31例）	统计值	P值
尿量（ml/h，±s）		63.0±45.6	82.1±38.7	t=1.754	0.021
血肌酐（μmol/L，±s）		185.7±168.4	64.4±21.2	t=-3.851	<0.001
血尿素氮（mmol/L，±s）		14.1±6.9	6.8±3.9	t=-4.972	<0.001
血β2微球蛋白（mg/L，±s）		6.9±3.1	2.4±0.8	t=-7.645	<0.001
血NGAL（μg/L，±s）		385.0±170.9	238.3±158.4	t=-3.451	0.001
血清胱抑素C（mg/L，±s）		2.0±1.2	0.9±0.4	t=-4.880	<0.001
PCT（μg/L，±s）		42.6±42.3	12.9±26.5	t=-3.231	0.002
NT-proBNP（ng/L，±s）		7149.4±8146.4	1579.2±1345.9	t=-3.636	0.001
尿蛋白（例）		?	?	u=-2.775	0.006
?	-	3	12	?	?
?	±	5	7	?	?
?	＋	13	8	?	?
?	＋＋	2	2	?	?
?	＋＋＋	6	2	?	?

肾脏相关指标	P值	OR值	95%CI
血肌酐	0.000	1.065	1.033~1.099
血尿素氮	0.000	1.286	1.121~1.476
血β2微球蛋白	0.000	6.669	2.472~17.995
血NGAL	0.001	1.008	1.003~1.013
血清胱抑素C	0.000	34.224	5.165~226.794
PCT	0.006	1.025	1.007~1.043
NT-proBNP	0.010	1.001	1.000~1.001
尿蛋白	0.01	1.828	1.158~2.886

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