血清胱抑素C检测在脓毒症诱导的肾损伤诊断及肾功能恢复预测中的价值

Value of Serum Cystatin C Measurement in the Diagnosis of Sepsis-Induced Kidney Injury and Prediction of Renal Function Recovery.

作者信息

Leem Ah Young, Park Moo Suk, Park Byung Hoon, Jung Won Jai, Chung Kyung Soo, Kim Song Yee, Kim Eun Young, Jung Ji Ye, Kang Young Ae, Kim Young Sam, Kim Se Kyu, Chang Joon, Song Joo Han

机构信息

Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

出版信息

Yonsei Med J. 2017 May;58(3):604-612. doi: 10.3349/ymj.2017.58.3.604.

PURPOSE

Acute kidney injury (AKI) is common in critically ill patients. Serum cystatin C has emerged as a reliable marker of AKI. We sought to assess the value of serum cystatin C for early detection and prediction of renal function recovery in patients with sepsis.

MATERIALS AND METHODS

Sepsis patients (113 AKI patients and 49 non-AKI patients) admitted to the intensive care unit (ICU) were included. Serum creatinine and cystatin C levels and glomerular filtration rate were measured on days 0, 1, 3, and 7.

RESULTS

Serum cystatin C levels were significantly higher in AKI patients than in non-AKI patients at all time points. Multivariate analysis showed that only serum cystatin C levels on day 0 were associated with AKI development [odds ratio (OR)=19.30; 95% confidence interval (CI)= 2.58-144.50, p<0.001]. Linear mixed model analysis showed significant variation in cystatin C levels between the recovery and non-recovery groups over time (p=0.001). High levels of serum cystatin C at day 0 (OR=1.64; 95% CI=1.00-2.68, p=0.048) were associated with recovery of AKI.

CONCLUSION

Serum cystatin C level was found to be associated with the development and worsening of AKI in ICU patients with sepsis.

目的

急性肾损伤（AKI）在危重症患者中很常见。血清胱抑素C已成为AKI的可靠标志物。我们旨在评估血清胱抑素C在脓毒症患者早期检测及肾功能恢复预测方面的价值。

材料与方法

纳入入住重症监护病房（ICU）的脓毒症患者（113例AKI患者和49例非AKI患者）。在第0、1、3和7天测量血清肌酐、胱抑素C水平及肾小球滤过率。

结果

在所有时间点，AKI患者的血清胱抑素C水平均显著高于非AKI患者。多因素分析显示，仅第0天的血清胱抑素C水平与AKI的发生相关[比值比（OR）=19.30；95%置信区间（CI）=2.58 - 144.50，p<0.001]。线性混合模型分析显示，随着时间推移，恢复组和未恢复组的胱抑素C水平存在显著差异（p = 0.001）。第0天血清胱抑素C水平高（OR = 1.64；95% CI = 1.00 - 2.68，p = 0.048）与AKI的恢复相关。