| Objective:Sepsis is a lethal organ dysfunction caused by a dysregulated host response to infection,and is a primary and crucial precipitating factor of AKI in critically ill patients.Inflammatory Cascade and microcirculatory disturbance play essential roles in the initiation of S-AKI,so it is critical to identify related clinical indicators such as procalcitonin(PCT)and lactic acid(Lac)to predict S-AKI.Through retrospective analysis of clinical data,this study explored the risk factors of S-AKI and clarified diagnostic and prognostic value of PCT and Lac in sepsis patients.Patients and Methods:A retrospective study was designed which included 122 patients who were admitted to the ICU from January 2020 to August 2018 in Shanxi Bethune Hospital.According to S-AKI diagnostic criteria,patients were divided into S-AKI group(69cases)and N-AKI group(53cases);According to whether the patients died,the patients were divided into survival group(47cases)and death group(22cases).Demographic data and clinical characteristics within 24 h after admission of the two groups were compared,Logistic regression was used to analyze independent risk factors and Receiver Operating Characteristic Curve(ROC)method was used to analyze the Area Under the Curve(AUC)to determine the diagnostic and prognostic value of PCT as well as Lac.Results:(1)A total of 122 sepsis patients were enrolled,of which 69 patients(56.6%)developed AKI and 53 patients(43.4%)did not,the total number of deaths is 30(24.6%).Compared with N-AKI patients,levels of PCT,SCr,APTT and Lac were significantly higher in S-AKI patients,but PLT was lower(P(27)0.05).(2)The univariate Logistic regression analysis show that PCT(OR(28)1.098;95%CI:1.058～1.140;P<0.001),Lac(OR(28)2.327;95%CI:1.541 ～ 3.513;P<0.001),SCr(OR(28)1.082;95%CI:1.048～1.117;P<0.001)and APTT(OR(28)1.112;95%CI:1.024～1.208;P(28)0.012)were risk factors for sepsis patients(P<0.05).(3)PCT(OR(28)1.070;95%CI:1.005 ～1.138;P(28)0.033),Lac(OR(28)3.903;95%CI:1.345～11.324;P(28)0.012)and SCr(OR(28)1.115;95%CI:1.054 ～ 1.179;P<0.001)were independent risk factors for S-AKI.(4)AUC values of PCT and Lac were 0.828(0.752,0.904)and 0.725(0.636,0.814),respectively.The ROC analysis showed that the cutoff point for PCT and Lac to predict AKI were8.41ng/m L(sensitivity was 87%,specificity was 73.6%)and 2.25 mmol/L(sensitivity was 65.2% and specificity was 75.5%);For the Combinations of PCT and Lac,the AUC was 0.856(0.787,0.925),sensitivity and specificity were 73.9% and 88.7%,respectively.(5)Among 69 patients with sepsis-associated AKI,22(31.9%)died and47(68.1%)survived.HR,PCT and Lac were statistically significant for death in sepsis patients.(6)The univariate Logistic regression analysis show that PCT(OR(28)1.061;95% CI: 1.022～1.100;P(28)0.002),Lac(OR(28)1.673;95%CI:1.143～2.450;P(28)0.008)and HR(OR(28)1.046;95%CI:1.015～ 1.078;P(28)0.003)were risk factors for death in sepsis patients(P<0.05).(7)Binomial logistic regression analysis showed that PCT(OR(28)1.062;95%CI:1.014 ～ 1.112;P(28)0.010)and Lac(OR(28)1.520;95%CI:1.043 ～2.217;P(28)0.029)were independent risk factors for death in sepsis patients(P<0.05).ROC curve analysis showed that the AUC of PCT and Lac for predicting the mortality of sepsis-associated AKI were 0.747(0.619,0.874)and 0.775(0.661,0.890),respectively,and the cut-off values were 22.03ng/m L(sensitivity was 81.8%,specificity was 54.7%)and 2.69mmol/L(sensitivity was 86.4%,specificity was 61.7%),for the Combinations of PCT and Lac,the AUC was 0.832(0.736,0.927),with sensitivity and specificity of 82% and 70.2%,respectively.Conclusions:PCT and Lac within 24 h of admission were independent risk factors for S-AKI patients,and both of them were great predictors of the S-AKI and the patients’ clinical outcomes during hospitalization. |
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