Research On The Relationship Between Serum Cystatin C,Urine Kidney Injury Molecule-1 Concentration And APACHEâ…¡ Scores With The Prognosis Of The Patients With Acute Injury Kidney

Objective: 1. To exploer the correlation between the serum CystatinC,urine kidney injury molecule-1 concentration(Cys C and kim-1,a specific marker for kidney injury) and acute physiology and chronic health evaluationⅡ(APACHEII, APⅡ) scores in patients with acute kidney injury. 2. To assess the prognostic value of Cys C and kim-1 elevation in patients with AKI.Methods: The clinical date of 49 patients with AKI form march 2008 to September 2008 were collected and analyzed, including gender, age,case history of chronic diseases,the worst values of laboratory examinations within 24 hours of diagnosis (including routine blood tests, blood gas analysis, renal function, blood electrolytes),therapies(including invasive ventilation, continuous renal replacement treat), acutep physiology and Chronic health evaluation (APACHE)Ⅱscores. The levels of serum CystatinC,urine kidney injury molecule-1 above the upper limit of normal value were considered elevated. The time of admission was regarded as zero point,then follow-up clinic outcome(death and survival)..First, univariate analysis was used to screen the variables that related to Prognosis, then Proceeded multiple-factor analysis with Logistic regression among to Perform the variables, which P value as below 0.05 in univariate analysis, Logistic regression analysis was used to identify Principal variables associated with death.Cumulative survival curves wereconstructed using the Kaplan-Meier method and compared with the log-rank test.A P value of < 0.05 was considered significant .Resultswere considered significant at P< 0.05. Statistical analysis was Performed with the SPSS13.0 statistical Package.Results: (1)Of the 49 acute kidney injury cases analyzed, 28 cases were males and 21 females, age ranged form 19 to 78 years (mean age 52.4±13.8 years).The overall mortality was 34.7%(17/49) within 60d of final diagnosis.(2) The higher of the APⅡscores, the higher of the serum CystatinC and Urine kidney injury molecule-1 concentration and the mortality(P<0.05),but Urine kidney injury molecule-1 concentration no significant in the APⅡ. (3) Univariate regression analysis indicated that the case fatality of patients with AKI was associated with the factors as follows: Cys C levels elevation plus APACHEⅡ> 15 scores,kim-1 levels elevation plus APACHEⅡ> 15 scores,Organ failure≥2,Oliguria,(4) The Kplan-Meier survival curve showed that the patients for elevated Cystatin C and high APACHEⅡscore of survival in the ICU was significantly lower in patients low Cystatin C and low APACHEⅡscore,low Cystatin C and low APACHEⅡscore,elevated Cystatin C and low APACHEⅡ(log-rank test,P<0.05); elevated kim-1 and high APACHE II score of survival in the ICU was significantly lower in patients low kim-1 and low APACHEⅡscore,low kim-1 and low APACHEⅡscore,elevated kim-1 with low APACHE II(log-rank test,P<0.05)Conclution: Elevated Cystatin C and Urine kidney injury molecule-1 leves had not only a predictive valuation for critical ill patients with AKI prognosis,along with the APACHEⅡscore,but also an additive effect on outcome prediction.