血清降钙素原与脓毒性休克患者急性肾损伤发生的相关性：一项回顾性队列研究。

Association between admission serum procalcitonin and the occurrence of acute kidney injury in patients with septic shock: A retrospective cohort study.

机构信息

Division of ICU, 562122Affiliated Hospital of Jining Medical University, Jining, Shandong, China.

Division of Nutrition, 562122Affiliated Hospital of Jining Medical University, Jining, Shandong, China.

出版信息

Sci Prog. 2021 Jul-Sep;104(3):368504211043768. doi: 10.1177/00368504211043768.

DOI:10.1177/00368504211043768

PMID:34558992

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10361585/

Abstract

BACKGROUND

Procalcitonin (PCT) is an effective and sensitive diagnostic biomarker that can facilitate the early detection of infection and septicemia, but whether it can similarly be utilized to predict the development of acute kidney injury (AKI) in patients suffering from septic shock remains to be established. Herein, the relationship between serum PCT at admission and the onset of AKI in septic shock patients was thus evaluated following adjustment for other potential covariates.

METHODS

This was a retrospective cohort study of 303 septic shock patients treated in a Chinese hospital between May 2015 and May 2019. All patients in whom PCT levels were measured on admission and who did not exhibit AKI or chronic kidney disease at the time of admission were assessed for AKI development within one week following intensive care unit (ICU) admission as per the KDIGO criteria. The relationship between serum PCT at admission and AKI incidence was then assessed for these patients.

RESULTS

These 303 patients were an average of 64 years old, and were 59.7% male. Of these patients, 50.5% developed AKI within the first 7 days following ICU admission. A dully-adjusted binary logistic regression analysis revealed PCT levels at admission to be associated with AKI following adjustment for potential confounding factors (odds ratio (OR) = 1.01, 95%CI (1.01,1.02), = 0.0007). Receiver operating characteristic curve analysis further indicated that a PCT cutoff level of 52.59 ng/ml at admission was able to predict the incidence of AKI with respective sensitivity and specificity values of 50% and 84%. Interaction analysis revealed no significant interactive relationship between PCT and AKI, suggesting that serum PCT levels represent an early predictor of AKI incidence in septic shock patients.

CONCLUSIONS

Serum PCT at the time of admission can be used as a predictor of AKI in patients suffering from septic shock.

摘要

背景

降钙素原（PCT）是一种有效的、敏感的诊断生物标志物，有助于早期发现感染和败血症，但它是否也能用于预测败血症性休克患者发生急性肾损伤（AKI）尚不清楚。因此，本研究旨在调整其他潜在混杂因素后，评估入院时血清 PCT 与败血症性休克患者 AKI 发病之间的关系。

方法

这是一项回顾性队列研究，纳入了 2015 年 5 月至 2019 年 5 月期间在中国医院接受治疗的 303 例败血症性休克患者。所有患者入院时均测量了 PCT 水平，且入院时既无 AKI 也无慢性肾脏病，根据 KDIGO 标准，在入住重症监护病房（ICU）后 1 周内评估 AKI 发生情况。然后评估这些患者入院时血清 PCT 与 AKI 发生率之间的关系。

结果

303 例患者的平均年龄为 64 岁，男性占 59.7%。其中 50.5%的患者在入住 ICU 后 7 天内发生 AKI。经多因素调整的二元逻辑回归分析显示，入院时 PCT 水平与潜在混杂因素调整后的 AKI 相关（比值比（OR）=1.01，95%CI（1.01，1.02），P=0.0007）。受试者工作特征曲线分析进一步表明，入院时 PCT 截断值为 52.59ng/ml 时，预测 AKI 的灵敏度和特异度分别为 50%和 84%。交互作用分析显示，PCT 与 AKI 之间无显著交互关系，提示血清 PCT 水平是败血症性休克患者 AKI 发生率的早期预测指标。