尿液 sCD163 水平对脓毒症及相关急性肾损伤的诊断价值：一项前瞻性研究。
Diagnostic value of urine sCD163 levels for sepsis and relevant acute kidney injury: a prospective study.
机构信息
Department of Respiratory Medicine, Hainan Branch of the Chinese PLA General Hospital, Sanya, Hainan Province, 572013, China.
出版信息
BMC Nephrol. 2012 Sep 26;13:123. doi: 10.1186/1471-2369-13-123.
BACKGROUND
Sepsis is a common syndrome in critically ill patients and easily leads to the occurrence of acute kidney injury (AKI), with high mortality rates. This study aimed to investigate the diagnostic value of urine soluble CD163 (sCD163) for identification of sepsis, severity of sepsis, and for secondary AKI, and to assess the patients' prognosis.
METHODS
We enrolled 20 cases with systemic inflammatory response syndrome (SIRS), 40 cases with sepsis (further divided into 17 sepsis cases and 23 severe sepsis cases) admitted to the intensive care unit (ICU), and 20 control cases. Results for urine sCD163 were recorded on the day of admission to the ICU, and AKI occurrence was noted.
RESULTS
On the day of ICU admission, the sepsis group exhibited higher levels of urine sCD163 (74.8 ng/ml; range: 47.9-148.3 ng/ml) compared with those in the SIRS group (31.9 ng/ml; 16.8-48.0, P < 0.001). The area under the curve (AUC) was 0.83 (95% confidence interval [CI]: 0.72-0.94, P < 0.001) the sensitivity was 0.83, and the specificity was 0.75 (based on a cut-off point of 43.0 ng/ml). Moreover, the severe sepsis group appeared to have a higher level of sCD163 compared with that in the sepsis group (76.2; 47.2-167.5 ng/ml vs. 74.2; 46.2-131.6 ng/ml), but this was not significant. For 15 patients with AKI, urine sCD163 levels at AKI diagnosis were significantly higher than those of the remaining 35 sepsis patients upon ICU admission (121.0; 74.6-299.1 ng/ml vs. 61.8; 42.8-128.3 ng/ml, P = 0.049). The AUC for urine sCD163 was 0.688 (95% CI: 0.51-0.87, P = 0.049). Sepsis patients with a poor prognosis showed a higher urine sCD163 level at ICU admission (98.6; 50.3-275.6 ng/ml vs. 68.0; 44.8-114.5 ng/ml), but this was not significant. Patients with AKI with a poor prognosis had higher sCD163 levels than those in patients with a better prognosis (205.9; 38.6-766.0 ng/ml vs. 80.9; 74.9-141.0 ng/ml), but this was not significant.
CONCLUSIONS
This study shows, for the first time, the potential value of urine sCD163 levels for identifying sepsis and diagnosing AKI, as well as for assessment of patients' prognosis.
TRIAL REGISTRATION
ChiCTR-ONC-10000812.
背景
脓毒症是危重症患者中常见的综合征，容易导致急性肾损伤（AKI）的发生，死亡率较高。本研究旨在探讨尿可溶性 CD163（sCD163）对脓毒症、脓毒症严重程度以及继发性 AKI 的诊断价值，并评估患者的预后。
方法
我们纳入了 20 例全身炎症反应综合征（SIRS）患者、40 例脓毒症患者（进一步分为 17 例脓毒症和 23 例严重脓毒症）和 20 例对照患者。记录患者入住重症监护病房（ICU）当天的尿 sCD163 结果，并观察 AKI 的发生情况。
结果
入住 ICU 当天，脓毒症组的尿 sCD163 水平（74.8ng/ml；范围：47.9-148.3ng/ml）明显高于 SIRS 组（31.9ng/ml；16.8-48.0，P<0.001）。曲线下面积（AUC）为 0.83（95%置信区间[CI]：0.72-0.94，P<0.001），灵敏度为 0.83，特异性为 0.75（基于 43.0ng/ml 的截断值）。此外，严重脓毒症组的 sCD163 水平似乎高于脓毒症组（76.2；47.2-167.5ng/ml 比 74.2；46.2-131.6ng/ml），但无统计学意义。对于 15 例 AKI 患者，AKI 诊断时的尿 sCD163 水平明显高于其余 35 例脓毒症患者入住 ICU 时的水平（121.0；74.6-299.1ng/ml 比 61.8；42.8-128.3ng/ml，P=0.049）。尿 sCD163 的 AUC 为 0.688（95%CI：0.51-0.87，P=0.049）。入住 ICU 时预后不良的脓毒症患者的尿 sCD163 水平较高（98.6；50.3-275.6ng/ml 比 68.0；44.8-114.5ng/ml），但无统计学意义。预后不良的 AKI 患者的 sCD163 水平高于预后良好的患者（205.9；38.6-766.0ng/ml 比 80.9；74.9-141.0ng/ml），但无统计学意义。
结论
本研究首次表明，尿 sCD163 水平对识别脓毒症和诊断 AKI 以及评估患者预后具有潜在价值。
临床试验注册
ChiCTR-ONC-10000812。
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