Xie Yun, Zhang Yi, Tian Rui, Jin Wei, Du Jiang, Zhou Zhigang, Wang Ruilan
Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Songjiang, 201600, Shanghai, People's Republic of China.
Department of Rheumatology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Clin Exp Med. 2021 Feb;21(1):89-100. doi: 10.1007/s10238-020-00656-x. Epub 2020 Aug 31.
The incidence of sepsis-associated acute kidney injury (AKI) is on the rise. Recent studies have found a correlation between antithrombin III and AKI. We established a predictive model for sepsis-associated AKI based on plasma ATIII levels. A prospective study (March 2018-January 2020) was conducted in sepsis patients admitted to the Critical Care Medicine Department at Shanghai General Hospital. ATIII levels were obtained within 48 h after admission to the ICU and before the diagnosis of sepsis-associated AKI was recorded. Renal function was assessed by measuring serum creatinine levels and urine volume. Male sex, other cardiovascular disease, and low ATIII levels were identified as independent risk factors for AKI. Age, immune disease, and low ATIII levels were identified as independent risk factors for death. Plasma ATIII levels in the non-AKI group were higher than those in the AKI group, plasma ATIII levels were higher in the survival group than in the non-survival group, plasma ATIII levels in the non-CRRT group were higher than those in the CRRT group, and plasma ATIII levels in the non-CKD group were higher than those in the CKD group. ATIII was significantly higher in the group with pulmonary infection than in the group without pulmonary infection. ATIII was significantly lower in the celiac infection group than in the nonceliac infection group. There was no statistically significant difference between the ATIII in the gram-positive group and the gram-negative group. ATIII was significantly higher in medical patients than in surgical patients. The predictive model of sepsis-associated AKI established based on ATIII was ln[P/(1 - p)] = -1.211 × sex - 0.017 × ATIII + 0.022 × Cr + 0.004 × BUN - 2.8192. The model goodness-of-fit test (p = 0.000) and the area under the ROC curve of the model (0.9862) suggested that the model has a high degree of discrimination and calibration. ATIII reduction was closely related to the prognosis of patients with sepsis. ATIII reduction was an independent risk factor for sepsis-associated AKI and an independent risk factor for mortality in patients with sepsis. ATIII reduction could predict sepsis-associated AKI. Low ATIII predicted a poor prognosis.
脓毒症相关性急性肾损伤（AKI）的发病率正在上升。最近的研究发现抗凝血酶III与AKI之间存在关联。我们基于血浆抗凝血酶III（ATIII）水平建立了脓毒症相关性AKI的预测模型。对上海交通大学医学院附属新华医院重症医学科收治的脓毒症患者进行了一项前瞻性研究（2018年3月至2020年1月）。在入住重症监护病房（ICU）后48小时内且在记录脓毒症相关性AKI诊断之前获取ATIII水平。通过测量血清肌酐水平和尿量来评估肾功能。男性、其他心血管疾病和低ATIII水平被确定为AKI的独立危险因素。年龄、免疫疾病和低ATIII水平被确定为死亡的独立危险因素。非AKI组的血浆ATIII水平高于AKI组，存活组的血浆ATIII水平高于非存活组，非连续性肾脏替代治疗（CRRT）组的血浆ATIII水平高于CRRT组，非慢性肾脏病（CKD）组的血浆ATIII水平高于CKD组。肺部感染组的ATIII水平显著高于无肺部感染组。腹腔感染组的ATIII水平显著低于非腹腔感染组。革兰氏阳性组和革兰氏阴性组的ATIII水平之间无统计学显著差异。内科患者的ATIII水平显著高于外科患者。基于ATIII建立的脓毒症相关性AKI预测模型为ln[P/(1 - p)] = -1.211×性别 - 0.017×ATIII + 0.022×肌酐（Cr）+ 0.004×尿素氮（BUN） - 2.8192。模型拟合优度检验（p = 0.000）以及模型的受试者工作特征曲线（ROC）下面积（0.9862）表明该模型具有高度的区分度和校准度。ATIII降低与脓毒症患者的预后密切相关。ATIII降低是脓毒症相关性AKI的独立危险因素，也是脓毒症患者死亡的独立危险因素。ATIII降低可预测脓毒症相关性AKI。低ATIII预示预后不良。
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