Department of Critical Care Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
Nephrology (Carlton). 2021 Nov;26(11):872-878. doi: 10.1111/nep.13972. Epub 2021 Sep 28.
Persistent acute kidney injury (AKI) has been shown to be closely associated with poor prognosis in critical patients. Recent studies have shown that procalcitonin (PCT) is valuable for the early prediction of AKI in critically patients. Our aim was to determine whether PCT and its kinetic changes could predict the occurrence of persistent AKI in critical patients.
This is a prospective observational study. The definition of AKI was based on the Kidney Disease: Improving Global Outcomes criteria. Persistent AKI was defined as renal function that does not return to baseline serum creatinine levels within 48 h. Blood samples were obtained at the onset of AKI and two subsequent days of hospital stay. 24-h PCT change (ΔPCT-24 h) was defined as 24 h PCT minus baseline PCT (day 0).
A total of 91 critical patients with AKI were included in this study. The persistent AKI group had a stepwise increase in PCT concentration. ΔPCT-24 h was higher in the persistent AKI group (p < .01). Logistic regression analysis showed that ΔPCT-24 h (p = .04) was independent predictors of persistent AKI. The receiver operating characteristic curves showed that area under the curve of ΔPCT-24 h was 0.84 (p < .01), and the cut-off value for PCT to predict persistent AKI was 0.56 ng/ml.
Our study showed that the observation of kinetic changes in PCT is more significant for the early prediction of persistent AKI than the index of PCT at a single time point. ΔPCT-24 h is a good predictor of persistent AKI in critical patients.
持续性急性肾损伤（AKI）与危重症患者的不良预后密切相关。最近的研究表明，降钙素原（PCT）对于预测危重症患者 AKI 具有重要价值。我们的目的是确定 PCT 及其动力学变化是否可以预测危重症患者持续性 AKI 的发生。
这是一项前瞻性观察性研究。AKI 的定义基于肾脏病：改善全球结局（KDIGO）标准。持续性 AKI 定义为肾功能在 48 小时内未恢复至基线血清肌酐水平。在 AKI 发生时和住院后两天内采集血液样本。24 小时 PCT 变化（ΔPCT-24 小时）定义为 24 小时 PCT 减去基线 PCT（第 0 天）。
本研究共纳入 91 例 AKI 危重症患者。持续性 AKI 组 PCT 浓度呈逐步升高趋势。持续性 AKI 组的ΔPCT-24 小时更高（p<.01）。Logistic 回归分析显示，ΔPCT-24 小时（p=.04）是持续性 AKI 的独立预测因子。受试者工作特征曲线显示，ΔPCT-24 小时的曲线下面积为 0.84（p<.01），预测持续性 AKI 的 PCT 截断值为 0.56ng/ml。
本研究表明，与单次 PCT 指数相比，观察 PCT 的动力学变化对早期预测持续性 AKI 更有意义。ΔPCT-24 小时是预测危重症患者持续性 AKI 的良好指标。
