Drey Michael, Behnes Michael, Kob Robert, Lepiorz Dominic, Hettwer Stefan, Bollheimer Cornelius, Sieber Cornel C, Bertsch Thomas, Hoffmann Ursula
Clin Lab. 2015;61(1-2):69-76. doi: 10.7754/clin.lab.2014.140724.
One of the main causes of acute kidney injury (AKI) in patients treated on an intensive care unit (ICU) is sepsis. The identification of new biomarkers indicating the early development and future course of AKI are of utmost medical interest. The C-terminal agrin fragment (CAF) is measurable in blood serum and might reflect kidney function. Therefore, this study evaluates CAF in patients presenting to an internal ICU with severe sepsis or septic shock. Serum levels of CAF are correlated with biomarkers of kidney function, markers of systemic inflammation, and the presence of AKI and renal replacement therapy (RRT).
61 patients suffering from severe sepsis or septic shock were included during the first 24 hours of ICU treatment and blood samples for biomarker measurements, i.e., CAF, creatinine, cystatin C, procalcitonin (PCT), interleukin 6, C reactive protein (CRP), and white blood cells (WBC) were collected on the first day of intensive care treatment. The number of RRT days and the incidence of AKI were documented.
13% of the patients (8/61) suffered from SIRS/sepsis, 20% (12/61) from severe sepsis, and 67% (41/61) from septic shock. Serum levels of CAF significantly correlated with creatinine (r = 0.623, p < 0.001) and cystatin C (r = 0.578, p < 0.001). Multiple linear regression analyses adjusting CAF for inflammatory parameters (i.e., WBC, CRP, interleukin 6, PCT), age, and gender showed a strong correlation between CAF and creatinine (r = 0.643, p < 0.001). Serum levels of CAF were significantly associated with the need of RRT (area under the curve (AUC) = 0.772, 95% CI: 0.641-0.903, p = 0.002) and the incidence of AKI (AUC = 0.721, 95% CI: 591-0.850, p = 0.004) as indicated by ROC analysis.
In patients suffering from severe sepsis and septic shock, serum levels of CAF were significantly associated with kidney function and RRT and were not influenced by severe septic conditions.
在重症监护病房（ICU）接受治疗的患者中，急性肾损伤（AKI）的主要原因之一是脓毒症。识别能够指示AKI早期发展和未来病程的新生物标志物具有极大的医学意义。C端集聚蛋白片段（CAF）可在血清中检测到，可能反映肾功能。因此，本研究评估了入住内科ICU的严重脓毒症或脓毒性休克患者的CAF情况。CAF的血清水平与肾功能生物标志物、全身炎症标志物以及AKI和肾脏替代治疗（RRT）的存在情况相关。
61例患有严重脓毒症或脓毒性休克的患者在ICU治疗的最初24小时内被纳入研究，并在重症监护治疗的第一天采集血样用于生物标志物测量，即CAF、肌酐、胱抑素C、降钙素原（PCT）、白细胞介素6、C反应蛋白（CRP）和白细胞（WBC）。记录RRT天数和AKI的发生率。
13%的患者（8/61）患有全身炎症反应综合征/脓毒症，20%（12/61）患有严重脓毒症，67%（41/61）患有脓毒性休克。CAF的血清水平与肌酐（r = 0.623，p < 0.001）和胱抑素C（r = 0.578，p < 0.001）显著相关。对炎症参数（即WBC、CRP、白细胞介素6、PCT）、年龄和性别进行校正后，CAF与肌酐之间存在很强的相关性（r = 0.643，p < 0.001）。ROC分析表明，CAF的血清水平与RRT需求（曲线下面积（AUC） = 0.772，95%可信区间：0.641 - 0.903，p = 0.002）和AKI发生率（AUC = 0.721，95%可信区间：591 - 0.850，p = 0.004）显著相关。
在患有严重脓毒症和脓毒性休克的患者中，CAF的血清水平与肾功能和RRT显著相关，且不受严重脓毒症状态的影响。
