[补体及凝血指标在脓毒症相关急性肾损伤中的预测价值]
[Predictive value of complement and coagulation indicators in sepsis related acute kidney injury].
作者信息
Chu L P, Yu Y F, Guo L C, Peng J Q, Zhou L F, Wei H Y, Du P F, Wang Y, Jiang D H
机构信息
Department of Nephrology, Affiliated Hospital of Jiangnan University, Wuxi 214062, China.
Department of Intensive Care Unit, Affiliated Hospital of Jiangnan University, Wuxi 214062, China.
出版信息
Zhonghua Nei Ke Za Zhi. 2020 Nov 1;59(11):854-859. doi: 10.3760/cma.j.cn112138-20200330-00322.
To explore the predictive value of complement and coagulation indicators in sepsis related acute kidney injury (AKI). Clinical data of 217 patients with sepsis admitted to the Department of Internal Medicine and Intensive Care Unit of Affiliated Hospital of Jiangnan University from January 2018 to June 2019 were retrospectively analyzed. All patients were divided into sepsis with AKI group and without AKI group. Laboratory indicators of all patients were collected, including complement C, complement C, activated partial thrombin time (APTT), prothrombin time (PT), international normalized ratio (INR), D-dimer, procalcitonin(PCT), etc. logistic regression analysis was used to explore the risk factors of sepsis related AKI. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of independent risk factors. Among 217 patients, 120 patients developed sepsis related AKI and 97 patients didn't. PCT, lactic acid, PT, APTT, INR and D-dimer in AKI patients were significantly higher than those without AKI (<0.01). Complement C and complement C were significantly lower in AKI group (<0.01). Multivariate logistic regression analysis suggested that blood pressure<90/60 mmHg (1 mmHg=0.133 kPa)(=3.705, 95% 1.536-8.934,=0.004), increased lactic acid (=1.479, 95% 1.089-2.008, =0.012), decreased complement C (=0.027, 95% 0.005-0.152, <0.001) and prolonged APTT (=1.090, 95% 1.047-1.137,<0.001)were independent risk factors predicting AKI. The area under the ROC curve (AUC) of these multivariates were 0.741 (95% 0.675-0.807), 0.798 (95% 0.732-0.864), 0.712 (95% 0.643-0.781) and 0.716 (95% 0.648-0.783) respectively. The relevant sensitivity was 57.5%, 80.8%, 87.5%, 59.2%, and the specificity was 90.7%, 75.3%, 51.5%, 77.3%, respectively. The AUC of the combined four indicators was 0.880 (95 0.835-0.926) with the sensitivity 75.0% and the specificity 90.7%. The low level of complement C and prolonged APTT predict sepsis related AKI, and the predictive value can be enhanced if hypotension and hyperlactacidemia are added.
探讨补体和凝血指标在脓毒症相关急性肾损伤（AKI）中的预测价值。回顾性分析2018年1月至2019年6月江南大学附属医院内科及重症监护病房收治的217例脓毒症患者的临床资料。将所有患者分为脓毒症合并AKI组和未合并AKI组。收集所有患者的实验室指标，包括补体C、补体C、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、国际标准化比值（INR）、D-二聚体、降钙素原（PCT）等。采用逻辑回归分析探讨脓毒症相关AKI的危险因素。采用受试者工作特征曲线（ROC）评估独立危险因素的预测价值。217例患者中，120例发生脓毒症相关AKI，97例未发生。AKI患者的PCT、乳酸、PT、APTT、INR和D-二聚体显著高于未发生AKI的患者（<0.01）。AKI组补体C和补体C显著降低（<0.01）。多因素逻辑回归分析表明，血压<90/60 mmHg（1 mmHg = 0.133 kPa）（=3.705，95% 1.536 - 8.934，=0.004）、乳酸升高（=1.479，95% 1.089 - 2.008，=0.012）、补体C降低（=0.027，95% 0.005 - 0.152，<0.001）和APTT延长（=1.090，95% 1.047 - 1.137，<0.001）是预测AKI的独立危险因素。这些多因素的ROC曲线下面积（AUC）分别为0.741（95% 0.675 - 0.807）、0.798（95% 0.732 - 0.864）、0.712（95% 0.643 - 0.781）和0.716（95% 0.648 - 0.783）。相关敏感度分别为57.5%、80.8%、87.5%、59.2%，特异度分别为90.7%、75.3%、51.5%、77.3%。四项指标联合的AUC为0.880（95% 0.835 - 0.926），敏感度为75.0%，特异度为90.7%。补体C水平降低和APTT延长可预测脓毒症相关AKI，若加入低血压和高乳酸血症，预测价值可增强。
Zotero 插件