Predictive Role Of Multiple Biomarkers In Sepsis-Associated Acute Kidney Injury

Objective:To investigate the application value of HBP(Heparin-Binding Protein),NGAL(Neutrophil Gelatinase-Associated Lipocalin),and Cys-C(Cystatin C)in predicting and diagnosing SA-AKI(Sepsis-Associated Acute Kidney Injury).Methods:A prospective observational study was conducted.Sepsis patients admitted to the intensive care unit(ICU)at Changshu First People’s Hospital from November 2021 to March 2023were enrolled.The general information of the enrolled patients,such as past medical history,height,weight,blood pressure,renal function,and site of infection,was collected.Biomarker data was collected at 0h,12h,24h,48h,and 72h after admission to the ICU.The enrolled patients were stratified according to the KIDGO criteria,and the data was statistically analyzed.Results:1.From November 2021 to March 2023,we received 109 sepsis patients.Finally 58 cases were included according to the inclusion criteria.According to the patients’creatinine levels,the data was stratified into Group SA-AKI(n=25)and Group non-SA-AKI(n=46).There was no significant difference in baseline data between the two groups(P<0.05).2.The statistical comparison between the biomarkers of the two groups shows that the concentration differences of HBP,NGAL,and Cys-C at admission(0h)are most significant among the collected biomarker data at different time points,with P<0.05.ROC curves were drawn for the three biomarkers at the initial(0h)concentration,with areas under the curve[confidence intervals]of 0.668[0.532,0.804],0.752[0.631,0.874],and 0.731[0.612,0.862],respectively.3.The three biomarkers’ concentrations at admission(0h)were transformed into binary variables according to the optimal cutoff values,and a multivariate regression analysis was conducted.The results show that the three biomarkers are all risk factors for SA-AKI,with P<0.05.A three-factor combined prediction ROC curve was drawn based on the three biomarker concentrations at admission(0h),with an area under the curve of 0.845[confidence interval:0.748-0.942].The biomarker concentrations at 12h,24h,48h,and 72h were transformed into binary variables and analyzed by multivariate regression.ROC curves were drawn for the combination of biomarkers.Conclusions:The concentrations of HBP,NGAL,and Cys-C at admission(0h)can effectively predict SA-AKI,and the predictive efficacy can be further improved by combining the three biomarkers.The predictive ability of the three biomarkers on SA-AKI is weakening,until admission(48h)they no longer have the combined predictive ability.It is supposed that multiple biomarker concentrations have the higher prediction accuracy and the higher application value.for patients with sepsis,who are before adimission to ICU.