| Objective:In this study,a retrospective analysis was conducted to compare Plasma neutrophil gelatinaseassociated lipocalin(Plasma neutrophil gelatinase associated lipocalin,pNGAL),acute physiological and chronic health evaluation Ⅱ(Acute physiology and chronic health evaluationⅡ,APACHE Ⅱ)score and their combination in the prediction of acute kidney injury(Acute kidney injury,AKI)secondary to sepsis.It provides a basic basis for clinicians to detect,diagnose,intervene illness and judge the prognosis of patients.Methods:This study included 65 sepsis patients coming from the department of emergency medicine and intensive care Unit of affiliated Hospital of North Sichuan Medical College from November 2020 to November 2021,and collected the age,gender,LOS,complications,infection site,and treatment methods of all included patients.Monitoring and record patients admitted to hospital for the first time(within 24h)of general information including heartrate,body temperature(axillary temperature),breathing rate,mean arterial pressure(MAP),the arterial blood PH value,the white blood cell count(WBC),calcitonin(PCT)and C-reactive protein(CRP),lactic acid(LAC),serum creatinine(SCr),plasma neutrophil gelatinase associated lipocalin(pNGAL)and Serum creatinine detected within 24 to 48 hours.According to the occurrence of AKI within 7 days of hospitalization,Patients was divided into AKI group(n=45)and non-AKI group(n=20).AKI group was divided into AKI stage 1 group(n=15),AKI Stage 2 group(n=15)and AKI Stage 3 group(n=15)according to SCr changes of laboratory examination,urine volume and duration.The general data of patients in AKI group and non-AKI group were compared,and the differences of pNGAL level and APACHE Ⅱ score among non-AKI group,AKI-1 group,AKI-2 group and AKI-3 group were analyzed.Multivariate Logistic regression analysis was performed on variables with statistical significance in univariate Logistic regression analysis to explore the independent risk factors of AKI induced by sepsis.The receiver operating characteristic curves(ROC)of pNGAL,APACHE Ⅱ score and pNGAL level combined with APACHE Ⅱscore were plottedrespectively,and the area under the curve(AUC)was compared to find the optimal cut-off value of pNGAL level and APACHE Ⅱscore,and to evaluate the predictive value of the three for sepsis complicated with AKI.Results:1.A total of 65 sepsis patients were included in this study,including 20 sepsis-non-AKI patients(30.77%)and 45 sepsis-AKI patients(69.23%).Age,heart rate,body temperature(axillary temperature),respiratory rate,MAP,arterial blood PH,white blood cell count and SCr within 24 hours were the measurement data between the two groups,and there was no statistical significance between the two groups(P>0.05).Gender,renal replacement therapy,mechanical ventilation,vasoactive drugs,hormone therapy,history of hypertension,digestive tract infection and other infections were count data,and there was no statistical significance between groups(P>0.05).2.PCT,CRP,SCr detected within 24 to 48 hours,Lac,APACHE Ⅱ score and pNGAL level in AKI group were significantly higher than those in non-AKI group,and the proportion of diabetes,respiratory infection and urinary infection in AKI group was significantly higher than that in non-AKI group(P<0.05).3.Pairwise comparison between the non-AKI group,AKI-1 stage group,AKI-2 stage group and AKI-3 stage group showed that there was no significant difference in APACHE Ⅱ score between the non-AKI group-AKI-1 stage group and AKI-2 stage group-AKI-3 stage group(P>0.05).APACHE Ⅱscore was significantly increased among the rest of groups with the progression of AKI severity(non-AKI group x±s=15.10±3.08,AKI-1 stage group x±s=17.40±5.82,AKI-2stage group x±s=24.20±6.11,AKI-3stage group x±s=25.13±7.21,P<0.05).There was nostatistically significant difference in pNGAL level between non-AKI group-AKI-1stage group and AKI-1 stage group-AKI-2stage group(P>0.05),while pNGAL level among the rest of groups was significantly increased with the increase of AKI severity(non-AKI group M(Q,R)=132.20(90.25,200.85),AKI-1 stage group M(Q,R)=341.80(251.40,897.20),AKI-2 stage group M(Q,R)=365.00(303.00,498.30),AKI-3 stage group M(Q,R)=947.80(723.30,1775.60),P<0.05).4.After calculating the maximum value of Youden index for the observation indicators with significant difference between the non-AKI group and the AKI group,the cut-off value of each indicator was used as the optimal point of classification.Binary Logistic univariate analysis showedthat PCT≥9.585μg/L,Lac≥1.85mmol/L,CRP≥102.36mg/L,APACHE Ⅱ score≥19 and pNGAL≥294μg/L might be risk factors for AKI in sepsis patients(P<0.05 and OR>1).According to the results of univariate analysis,the indexes with statistical differences were included in multi-factor Logistic regression analysis.PCT≥9.585μg/L,Lac≥1.85 mmol/L,APACHE Ⅱ score≥19 and pNGAL≥294μg/L were independent risk factors for AKI in sepsis patients(P<0.05 and OR>1).5.The operating characteristic curves of subjects for pNGAL,APACHEⅡ score and pNGAL combined with APACHE Ⅱ score were drawn respectively.The AUC of the three was ranked from high to low as APACHEⅡ score combined with pNGAL test(AUC=0.883,CI=0.803～0.964),APACHEⅡ score(AUC=0.823,CI=0.724～0.923),pNGAL test(AUC=0.876,CI=0.789～0.962);The maximum Youden index of pNGAL+APACHE Ⅱ score,pNGAL and APACHE Ⅱ score were 0.706,0.683 and 0.583,respectively,corresponding cut-off value pNGAL=294μg/L and APACHE Ⅱ score=18.5.The specificity of the joint detection(95%)was higher than that of APACHE Ⅱ score(85%)and the same as that of pNGAL test(95%).Sensitivity(75.6%)was higher than pNGAL(73.3%)and APACHE Ⅱ score(73.3%).Conclusions:1.Within 24 hours of hospitalization,PCT,CRP,LAC,APACHE Ⅱscore,pNGAL level and SCr detected within 24 to 48 hours of sepsis patients increased,and AKI was likely to occurr.AKI is more likely to occur in sepsis patients with diabetes,and urinary and respiratory infections.2.pNGAL level and APACHE Ⅱ scorehas good predictive value for AKI secondary to sepsis,but its predictive efficacy for severity is limited.3.pNGAL level combined with APACHE Ⅱ score has high sensitivity and specificity for predicting AKI secondary to sepsis,and has good clinical predictive efficacy. |
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