The Correlation Between The Combined Detection Of KIM-1 And Cys C And The Timing Of Initiation Of CRRT In Patients With Sepsis AKI

Objective:To investigate the correlation between the combined detection of renal injury markers KIM-1 and Cys C and the timing of CRRT treatment in patients with sepsis AKI.Methods:A total of 40 hospitalized patients diagnosed with sepsis complicated with acute renal injury(AKI)in the emergency ICU and comprehensive ICU of chengde central hospital from November 2018 to August 2019 were collected.According to whether the patients had received CRRT during hospitalization,they were divided into two groups: group A required CRRT treatment,group B no CRRT treatment.The indications of CRRT treatment were as follows:(1)the severity of acute kidney injury reached the AKI2 stage:Scr increased to 2-2.9 times the basal level,and urine volume was less than 0.5ml/(kg*h)> 12h;(2)severe electrolyte disorder(hyperkalemia,etc.);(3)Capacity overload;(4)severe metabolic acidosis(blood p H < 7.15).Record patients' age,gender,infection site,the determination of urine Kidney injury within 24 h after diagnosis molecular 1(Kidney injury molecule 1,KIM-1),blood Cystatin C(Cystatin C,Cys C),creatinine,Scr,urine volume,within 24 h after admission to index the worst value calculation of acute physiology and chronic health evaluation(acute physiology and chronic health evaluation ?,APACHE ?),mean arterial pressure.Urine kim-1 detection kit is provided by wuhan pengsheng science and technology,and other indicators are provided by the laboratory department of our hospital.SPSS 23.0 statistical analysis software was applied.Age,leukocyte,creatinine,Cys C,kim-1,urine volume,APACHEII score,etc.of measurement data were tested for normality and expressed as mean ± standard deviation.The independent sample t test was used to compare the measurement data between the two groups.Enumeration data are expressed as a percentage and are compared using the chi-square test.The value of urine kim-1,Cys C concentration and their combination in predicting the timing of CRRT treatment for patients with sepsis AKI was evaluated by the receiver operatingcharacteristic(ROC)area under curve(AUC),and the jorden index predicted by kim-1,Cys C and their combination was also calculated.P<0.05 was considered statistically significant.Results:1.Comparison of general informationIn 40 patients with sepsis AKI,23 cases of male,female 17 cases,A,B two groups of patients in the gender,age,white blood cells,mean arterial pressure,heart rate,cause species(urinary tract infection,pulmonary infection,abdominal cavity infection)no statistically significant difference were observed in the data comparison(P > 0.05),explain the clinical data of patients with sepsis AKI CRRT treatment time has no obvious correlation,have no predictive value.In Scr?urine volume?urine KIM-1?blood Cys C?the APACHEII score difference had statistical significance(P < 0.05),showed that patients with urine KIM-1 and blood Cys C concentration,Scr,urine output,always health and disease severity are associated with the deterioration of renal function in patients with situation,have certain predict early in the development of disease in patients with sepsis AKI whether the value of the line of CRRT treatment is needed.2.The ROC curveDiagnosis of patients with sepsis AKI within 24 h urine KIM-1concentration,blood Cys C concentration and blood Cys C and urine KIM-1 joint detection for selected patients hospitalized during line whether CRRT treatment have predictive value of the area under the ROC curve analysis is as follows: KIM--1 is applied to forecast in patients with sepsis AKI CRRT treatment area under the ROC curve is 0.955(95% CI: 0.887 ? 1.000,P < 0.05);The surface product under the ROC curve of Cys C was 0.870(95%ci: 0.733? 1.000,P < 0.05).The area Combined detection under ROC curve of CRRT in patients with sepsis AKI was 0.973(95%ci: 0.932 ? 1.000,P < 0.05).ROC analysis results also showed: Cys-C predict early CRRT treatment of patients with sepsis AKI about maximum index was 0.561,KIM-1 is 0.567,and KIM-1 joint Cys C is 0.625,thus,KIM-1 and Cys C joint detection area under the ROC curve than KIM-1,Cys C area under the curve of the single clinical indexes such as detection,to prove that these two kinds of patients with kidney damage markers can predict AKI CRRT treatment,In addition,the predictive value of CRRT treatment in patients with sepsis AKI by the combined test is better than that of other relevant indicators alone,suggesting that the combined test has certain clinical guiding significance on whether CRRT treatment is needed in the disease progression of sepsis AKI patients.Conclusion:1.Urine kim-1 and blood Cys C can be used to judge the degree of renal injury at an early stage.2.Urine kim-1 and blood Cys C have early predictive value for CRRT treatment of sepsis patients with AKI.3.The predictive value of urine kim-1 combined with blood Cys C was better than that of both alone.