Department of Critical Care Medicine and Hospital Infection Prevention and Control, The Second People's Hospital of Shenzhen and First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China.
Department of General Surgery, The 3rd Xiangya Hospital, Central South University, Changsha, China.
Blood Purif. 2021;50(6):790-799. doi: 10.1159/000512351. Epub 2021 Mar 17.
The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock.
A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI.
Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009-1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929-0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022-1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009-1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001).
Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.
本研究旨在评估血清降钙素原（PCT）与细菌感染性休克引起的急性肾损伤（AKI）之间的关系。
设计了一项回顾性研究，纳入了 2015 年 1 月至 2018 年 10 月期间入住 ICU 的患者。采用多因素逻辑回归和受试者工作特征（ROC）曲线以及平滑曲线拟合分析评估 PCT 水平与 AKI 之间的关系。
在筛选的 1631 名患者中，157 名患者纳入了主要分析，其中 84 名（53.5%）患者发生 AKI。多因素逻辑回归结果显示，PCT（比值比[OR] = 1.017，95%置信区间[CI] 1.009-1.025，p < 0.001）与感染性休克引起的 AKI 相关。ROC 分析显示，PCT 预测 AKI 发生的截断点为 14ng/mL，灵敏度为 63%，特异性为 67%。具体而言，在多元分段线性回归中，当 PCT 在 25ng/mL 至 120ng/mL 之间时，AKI 的发生率随 PCT 的升高而降低（OR 0.963，95%CI 0.929-0.999；p = 0.042）。当 PCT < 25ng/mL（OR 1.077，95%CI 1.022-1.136；p = 0.006）或 >120ng/mL（OR 1.042，95%CI 1.009-1.076；p = 0.013）时，AKI 随 PCT 的升高而增加。此外，仅在年龄≤75 岁的女性患者中，AKI 组 PCT 水平显著升高（p = 0.001）。
本研究数据显示，感染性休克患者 PCT 与 AKI 之间存在非线性关系，PCT 可作为细菌感染性休克女性患者<75 岁 AKI 的潜在生物标志物。
