Clinical Study Of Antithrombin ? In Predicting Septic-Associated Acute Kidney Injury

Objective:Sepsis associated acute kidney injury(AKI)has a high morbidity and mortality,and early diagnosis is particularly important.Some studies have found that antithrombin III(AT?)not only plays a key role in anticoagulation in vivo,but also plays an important role in anti-inflammatory effects and is related to AKI.We reviewed and summarized the biomarkers associated with the diagnosis of sepsis associated AKI,and explored the predictive value of AT? in sepsis associated AKI in clinical studies.Method:Review of Chinese and English articles published before January11,2019 for a meta-analysis of biomarkers to diagnose sepsis associated AKI.A retrospective study(October 2015 to March 2018)and a prospective study(March 2018 to January 2020)were conducted on sepsis patients admitted to the ICU of Shanghai General Hospital.AT? levels were obtained within 48 hours after admission to ICU.Before the diagnosis of sepsis-associated AKI was recorded.Renal function was assessed by measuring serum creatinine levels and urine volume.Result:1.Novel biomarkers such as urine and serum neutrophils related lipid carrier protein(NGAL),urinary interleukin-18(IL-18),urinary kidney injury molecule-1(KIM-1),and urinary netrin-1 have performed well as auxiliary diagnostic indicators of sepsis-associated AKI.2.According to the SROC curve region,the order of diagnosis of sepsis associated AKI biomarkers was urine KIM-1 > urine NGAL> blood NGAL>urine IL-18.3.Reduced AT? level was a predictor of sepsis associated AKI in elderly patients(AUC-ROC = 0.729,sensitivity 0.700 and specificity 0.714).Reduced AT?/Cr ratio was also a predictor of sepsis associated AKI(AUC-ROC = 0.971,sensitivity 0.900,and specificity 1).AT? and AT?/Cr were moderately accurate in predicting survival,with an AUC-ROC of 0.681 and 0.804,respectively,with a sensitivity range of 0.802 and 0.596,and a specificity of 0.542 and 0.875.4.In the elderly patients with sepsis,the cutoff values were calculated using the Youden index,and they were divided into the low AT? group and the high AT? group.In contrast,the length of ICU stay in the high AT? group was significantly reduced,with no mechanical ventilation time,no CRRT time and significantly prolonged survival time.5.Male,other cardiovascular diseases and low AT? risk factors were identified as independent risk factors for sepsis associated AKI.Age,immune disease,and low AT? risk factors were identified as independent risk factors for death of sepsis.6.Plasma AT? level in the Non-AKI group was higher than that in the AKI group.Plasma AT? levels were higher in the survival group than in the non-survival group.Plasma AT? level in the No-CRRT group was higher than that in the CRRT group.Plasma AT? level of the No-CKD group was higher than that of the CKD group.7.AT? was significantly higher in the pulmonary infection group than in the non-pulmonary infection group.AT? was significantly lower in the abdominal infection group than in the Non-abdominal infection group.AT? is significantly higher in medical patients than in surgical patients.8.The prediction model of sepsis AKI established based on AT? was:IN[P/(1-p)]=-1.211Gender-0.017AT?+0.022Cr+0.004 BUN-2.8192.Model goodness of fit test P=0.000,the area under the ROC curve of the model=0.9862.It is suggested that the model has a high degree of discrimination and calibration.Conclusion:AT? reduction is an independent risk factor for sepsis associated AKI,as well as an independent risk factor for mortality of patients with sepsis.AT? reduction can predict sepsis-associated acute kidney injury.Low AT? predicted a poor prognosis.