Department of Critical Care Medicine, Third Hospital of HeBei Medical University, The 139rd of ZiQiang Road, ShiJiaZhuang, 050051, China.
Int Urol Nephrol. 2023 May;55(5):1229-1237. doi: 10.1007/s11255-022-03394-z. Epub 2022 Nov 4.
Acute kidney injury (AKI) is common in patients with sepsis and septic shock. Urine output and serum creatinine (SCr) levels are the criteria for diagnosing AKI. However, the application of these levels in the diagnosis of AKI has limitations.
To detect the expression of various adhesion factors in different stages of AKI as defined by Kidney Disease: Improving Global Outcomes (KDIGO) and to analyse their relationship with the prognosis of patients with sepsis-induced AKI (S-AKI).
Adult patients with sepsis who were admitted to the hospital between June 2019 and May 2020 were included. Of 90 adult patients with sepsis, 58 had S-AKI. Sixty-seven subjects without sepsis were used as controls. Enzyme-linked immunosorbent assay kits were used to measure E-selectin (CD62E), L-selectin (CD62L), P-selectin, intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), and their relationship with the prognosis of patients with S-AKI patients was analysed. Receiver operating characteristic curves were used to analyse the predictive value of different adhesion factors on renal resistance index and renal function recovery. Multivariate logistic regression analysis was used to identify factors associated with renal recovery.
The expression of CD62L was significantly higher in S-AKI patients than in non-AKI patients with sepsis. Compared with the non-AKI group, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were significantly higher in the AKI group than in the non-AKI group (P < 0.05). Mean blood pressure, SCr levels and procalcitonin levels were higher in the AKI group than in the non-AKI group (P < 0.05 for all). The CD62L levels decreased with increasing S-AKI stage. The CD62E levels were highest in S-AKI stage 2, and the VCAM-1 levels were highest in S-AKI stage 3. All patients with S-AKI were followed up with for 28 days. The results found that VCAM-1 was the best predictor of renal recovery in patients with S-AKI.
CD62L is an indicator of S-AKI stage1, and CD62E is an indicator of S-AKI stage 2. In addition, VCAM-I demonstrated satisfactory performance in predicting early recovery of renal function in patients with S-AKI.
急性肾损伤（AKI）在脓毒症和脓毒性休克患者中很常见。尿输出量和血清肌酐（SCr）水平是诊断 AKI 的标准。然而，这些水平在 AKI 诊断中的应用存在局限性。
检测不同阶段 AKI 中各种黏附因子的表达，根据肾脏病：改善全球预后（KDIGO）定义，并分析它们与脓毒症诱导的 AKI（S-AKI）患者预后的关系。
纳入 2019 年 6 月至 2020 年 5 月期间住院的脓毒症成年患者。在 90 名成年脓毒症患者中，有 58 名患有 S-AKI。67 名无脓毒症的患者作为对照组。使用酶联免疫吸附试剂盒测量 E-选择素（CD62E）、L-选择素（CD62L）、P-选择素、细胞间黏附分子 1（ICAM-1）和血管细胞黏附分子 1（VCAM-1），并分析其与 S-AKI 患者预后的关系。使用受试者工作特征曲线分析不同黏附因子对肾阻力指数和肾功能恢复的预测价值。多变量逻辑回归分析用于识别与肾恢复相关的因素。
与非 AKI 脓毒症患者相比，S-AKI 患者的 CD62L 表达明显升高。与非 AKI 组相比，AKI 组急性生理学和慢性健康评估 II 评分和序贯器官衰竭评估评分明显更高（P<0.05）。平均血压、SCr 水平和降钙素原水平在 AKI 组均高于非 AKI 组（P<0.05 均）。CD62L 水平随 S-AKI 分期的增加而降低。CD62E 水平在 S-AKI 第 2 期最高，而 VCAM-1 水平在 S-AKI 第 3 期最高。所有 S-AKI 患者均随访 28 天。结果发现，VCAM-1 是 S-AKI 患者肾功能恢复的最佳预测因子。
CD62L 是 S-AKI 第 1 期的指标，CD62E 是 S-AKI 第 2 期的指标。此外，VCAM-I 在预测 S-AKI 患者肾功能早期恢复方面表现出令人满意的性能。
