| Objective: Acute renal injury,formerly known as acute renal failure,refers to a sudden decline in renal function,is a group of clinical syndromes within 3 months.Some studies have showed that AKI(sepsis-induced AKI or septic AKI),which is caused by sepsis,accounts for about 50% of the total incidence of AKI.Sepsis related AKI patients have more urgent hospitalization,more complication and higher risk score.In addition,in clinical,serum creatinine(serum SCr)is still the detection index of the diagnosis and treatment of AKI,but it will be affected by protein intake and muscle mass,blood pressure and dietary factors,and which is no correlation with acute kidney injury.Therefore,SCr is not a time and accurate response to biomarker of sepsis related AKI,can also not be diagnosed at the early stage of AKI and can reverse renal injury in a timely manner and it is a very necessary to find new biomarker for sepsis related AKI.Therefore,this study explored the relationship between urinary N-acetylacetyl-?-D-glucosidase(NAG)and sepsis related AKI and the diagnostic value of NAG in this disease,so as to provide a theoretical basis for early diagnosis of sepsis related AKI.Methods: This was a retrospective study from January 2012 to December 2017 in the Affiliated Hospital of Medical College ICU(ICU),in this study,clinical data of patients with admitted sepsis were collected and enrolled,according to whether the AKI,these patients were divided into septic AKI group(A group)and sepsis non-AKI group(B group);then,according to the AKI staging,septic AKI patients were divided into mild AKI(A1group)and severe AKI(A2 group).The enzyme linked immunosorbent assay by enzyme-linked immunosorbent assay(ELISA)method was used to detect the expression of NAG in urine,diagnosis value of urine NAG in different degree of sepsis associated AKI was analyzed,the relationship between urine NAG and oxygenation index,urine volume,time in the ICU,whether with diuretics and CRRT was also analyzed.Results: A total of 156 sepsis patients were enrolled,according to whether the AKI,these patients were divided into septic AKI group(A group,n=105)and septic non-AKI group(B group,n=51);according to AKI staging,105 septic AKI patients were divided into mild AKI(A1 group,n=64)and severe AKI(A2group,n=41).For the first time,compared with the B group,the urine NAG expression of A group was increased(P<0.05);Compared with the A1 group,urine NAG level was further increased in A2 group(P<0.05).Secondly,the urine NAG can be diagnosed AKI patients from non-AKI patients,the diagnosis rate was 80.1%,the area under the curve(AUC)=0.816,the sensitivity was 81.2%,specificity was 79.2%,the diagnostic cut-off value is 2.2 U/mmol;the urine NAG can be diagnosed mild AKI patients from non-AKI patients,the diagnosis rate was 78.6% the area under the curve(AUC)=0.732,the sensitivity was 75.6%,specificity was 71.5%,the diagnostic cut-off value is 2.4 U/mmol;the urine NAG can be diagnosed severe AKI patients from non-AKI patients,the diagnosis rate was 88.4%,the area under the curve(AUC)=0.862,the sensitivity was 85.3%,specificity was 80.2% the diagnosis cut-off value is 3.2 U/mmol;the urine NAG can be diagnosed severe AKI patients from mild AKI patients,the diagnosis rate was 80.1%,the area under the curve(AUC)=0.793,the sensitivity was 75.6%,specificity was 76.8%,the diagnostic cut-off value is 4.5 U/mmol(P<0.05).Furthermore,the urine NAG level is superior to serum creatinine(SCr)in the diagnosis of sepsis related AKI(P<0.05).Finally,for those sepsis AKI patients with CRRT or death,the urine NAG levels were higher(P < 0.05);in sepsis associated AKI patients,the urine NAG level was negatively correlated with oxygenation index and urine volume;however,was positively correlated with APACHE II score,SOFA score,ICU retention time(P<0.05).Conclusions: The level of NAG in urine in patients with sepsis associated AKI was increased;the urine NAG level is superior to serum creatinine(SCr)in the diagnosis of sepsis related AKI;urine NAG level is positively related with the ICU time,the use of CRRT,passively related with tSCr value,urine volume and oxygenation index. |
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