Application Of Heme Oxygenase 1 In Etiology Diagnosis Of Severe Patients With Acute Kidney Injury

Objective:To investigate the expression of heme oxygenase 1(HO-1)in severe patients with acute kidney injury(AKI)and to compare it with neutropil gelatinase-associated lipocalin(NGAL).To explore the correlation between HO-1 and the etiology and severity of acute kidney injury in severe patients,and to understand the significance of HO-1 in judging the prognosis of patients with AKI.This will provide a scientific basis for the potential targets for the integration of AKI diagnosis and treatment.Methods:Patients who were admitted to the emergency ICU of The First Affiliated Hospital of Dalian Medical University from August 2020 to January 2021 were included.Inclusion criteria: Severely ill patients who meet the 2012 Kidney Disease:Improving Global Outcomes(KDIGO)for the diagnosis of Acute Kidney Injury,and AKI caused by renal parenchymal and post-renal etiology is excluded.According to the common clinical causes of AKI in critically ill patients,they are divided into sepsis shock group(Sepsis Shock,SS,n=24),other shock group(Other Shock,OS,n=14),and acute intoxication group(Acute Intoxication,AI,n=6),Cardiovascular and cerebrovascular diseases group(Cardiovascular and cerebrovascular diseases,CACD,n=14),other etiology groups(Other cause,OC,20).Basic clinical data of enrolled patients were collected and included in the normal control group(healthy people,n=10).The enzyme-linked immunosorbent assay(ELISA method)be used to determine the HO-1 and NGAL.Using SPSS 23.0 statistical software for statistical analysis.Patients were enrolled for AKI staging according to KDIGO criteria,Meanwhile,Spearman test was used for correlation analysis.The survival of the patients within 28 days was observed,and Kaplan-Meier method was used for survival analysis.P<0.05 indicated that the difference was statistically significant.Results:Age and gender of enrolled patients showed no statistical significance among all groups(P>0.05),and HO-1 showed no significant difference among different age and sex AKI groups(P>0.05);HO-1 in AKI group was significantly higher than it in healthy control group,and the difference was statistically significant(P<0.01);Serum HO-1 was positively correlated with NGAL;HO-1 and NGAL in AKI group were significantly higher than those in normal control group(P<0.01);HO-1 was significantly higher in AKI group than in CACD group,AI group and OC group(P<0.01),but there was no significant difference between SS group and OS group(P>0.05);The difference of NGAL among all groups was statistically significant(P<0.01),and the difference of NGAL in SS group was significantly higher than that in CACD group and OC group(P<0.01),but there was no statistical difference between SS group and OC group and AI group(P>0.05);No statistical significance was found in in different etiology of AKI(P>0.05);HO-1 was positively correlated with SCR(r=0.326,P=0.004),and positively associated with AKI(r= 0.330,P=0.003);NGAL was positively correlated with SCR(r=0.229,P=0.008),and positively associated with AKI(r=0.349,P=0.002);According to the median concentration of HO-1 in AKI patients(22.00 ng/ml),the HO-1 were divided into the high expression group and the low expression group.The survival curve of patients’ 28-day survival indicated that the low expression group and the high expression group had a high survival rate(P<0.05);According to the NGAL median concentration in serum in patients with AKI(115.19 ng/ml),it is divided into high expression and the low expression group,and the survival of patients with 28 days survival curve has no statistical significance(P>0.05).Conclusions:HO-1 can be used as a biomarker of AKI and may be related to the cause of AKI;Compared with NGAL and SCr,HO-1 may have certain advantages in the early diagnosis of AKI which caused by sepsis shock(SS);HO-1 may be related to the severity of AKI,and has certain guiding significance for the prognosis of AKI patients.