Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2022 Aug;45(4):665-674. doi: 10.1016/j.bj.2021.08.006. Epub 2021 Sep 3.
Sepsis-associated acute kidney injury (AKI) often worsens with the deterioration of a patient's condition. Therefore, we hypothesized that monitoring AKI dynamically from day 1 to day 3 was potential to predict hospital mortality. Specifically, we explored whether monitoring AKI dynamically in the intensive care unit (ICU) could be a sepsis phenotype predictive of mortality. A new classification was established based on the change in the AKI stage from admission day 1 and day 3. We compared the hospital mortality, cytokines, and immune response pattern between each group.
We retrospectively enrolled 523 patients with sepsis, and we calculated the AKI stages on day 1 and day 3 admission to ICUs. Among these 523 people, 388 of them were assigned to normal, improved, and deteriorated groups according to the changes in the AKI stages. 263 of which did not develop AKI on day 1 and day 3 (normal group). The AKI stage improved in 68 patients (improved group) and worsened in 57 (deteriorated group). We compared the mortality rates between the groups, and identified the relationship between the dynamic AKI status, immune response patterns, and cytokine levels.
The hospital mortality rate in the deteriorated group was higher than that in the non-deteriorated group (combination of normal and improved group) (p = 0.004). Additionally, according to the Kaplan-Meier analysis, the non-deteriorated group had a distinct hospital survival curve (p = 0.004). Furthermore, both the overexpression of tumor necrosis factor-α and decreased monocyte expression of human leukocyte antigen-DR were present in the deteriorated group.
The deteriorated group was associated with a higher hospital mortality rate, potentially resulting from an abnormal inflammatory response. Worsening AKI in the first 3 days of ICU admission may be a sepsis phenotype predictive of hospital mortality.
脓毒症相关性急性肾损伤（AKI）常随着病情恶化而加重。因此，我们假设从第 1 天到第 3 天动态监测 AKI 有可能预测住院死亡率。具体来说，我们探讨了在重症监护病房（ICU）中动态监测 AKI 是否可以作为预测死亡率的脓毒症表型。根据入院第 1 天和第 3 天 AKI 分期的变化，建立了一种新的分类。我们比较了各组之间的住院死亡率、细胞因子和免疫反应模式。
我们回顾性纳入了 523 例脓毒症患者，并计算了他们入住 ICU 第 1 天和第 3 天的 AKI 分期。在这 523 人中，根据 AKI 分期的变化，其中 388 人被分为正常、改善和恶化组。其中 263 人在第 1 天和第 3 天没有发生 AKI（正常组）。AKI 分期改善的有 68 例（改善组），恶化的有 57 例（恶化组）。我们比较了各组之间的死亡率，并确定了动态 AKI 状态、免疫反应模式和细胞因子水平之间的关系。
恶化组的住院死亡率高于非恶化组（正常组和改善组的组合）（p=0.004）。此外，根据 Kaplan-Meier 分析，非恶化组的住院生存率曲线明显不同（p=0.004）。此外，恶化组肿瘤坏死因子-α过度表达，单核细胞人类白细胞抗原-DR 表达减少。
恶化组与较高的住院死亡率相关，可能是由于异常的炎症反应所致。在 ICU 入院后的前 3 天内 AKI 恶化可能是预测住院死亡率的脓毒症表型。
