Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2023 Mar;64(3):181-190. doi: 10.3349/ymj.2022.0324.
Acute kidney injury (AKI) following sepsis is associated with higher mortality; however, reliable biomarkers for AKI development and recovery remain to be elucidated.
Patients with sepsis admitted to the medical intensive care unit (ICU) of Severance Hospital between June 2018 and May 2019 were prospectively analyzed. Patients were divided into those with and without AKI within 48 hours. Patients with septic AKI were subdivided into AKI-recovery and non-recovery groups based on whether their kidney injury recovered within 7 days.
A total of 84 patients were enrolled. The baseline creatinine (2.9 mg/dL vs. 0.8 mg/dL vs. 1.2 mg/dL, <0.001), Charlson Comorbidity Index (4.5 vs. 2.0 vs. 3.0, =0.002), Sequential Organ Failure Assessment (10.0 vs. 6.5 vs. 8.0, <0.001), and Acute Physiology and Chronic Health Evaluation II scores (32.0 vs. 21.5 vs. 30.5, =0.004) were higher in the non-recovery AKI group compared to the non-AKI and AKI-recovery groups. The Kaplan-Meier curves revealed that non-recovery from AKI was associated with lower survival (<0.001). High-lactate (≤0.05) and kynurenine levels (≤0.05) were associated with non-recovery of renal function following AKI. The areas under the curve for predicting non-recovery from AKI were 0.693 and 0.721 for lactate and kynurenine, respectively. The survival rate was lower in the high-kynurenine (=0.040) and high-lactate (=0.010) groups.
The mortality of patients who recovered from AKI was comparable to that of patients without AKI. Lactate and kynurenine could be useful biomarkers for the diagnosis and recovery of AKI following sepsis.
脓毒症相关的急性肾损伤（AKI）与更高的死亡率相关；然而，用于 AKI 发展和恢复的可靠生物标志物仍有待阐明。
2018 年 6 月至 2019 年 5 月期间，前瞻性分析了在首尔峨山医院内科重症监护病房（ICU）收治的脓毒症患者。将患者分为在 48 小时内发生 AKI 与未发生 AKI 的患者。根据肾功能损伤是否在 7 天内恢复，将患有脓毒症 AKI 的患者进一步分为 AKI 恢复组和未恢复组。
共纳入 84 例患者。基线时，未恢复 AKI 组的肌酐（2.9mg/dL 比 0.8mg/dL 比 1.2mg/dL，<0.001）、Charlson 合并症指数（4.5 比 2.0 比 3.0，=0.002）、序贯器官衰竭评估（10.0 比 6.5 比 8.0，<0.001）和急性生理学与慢性健康评估 II 评分（32.0 比 21.5 比 30.5，=0.004）均高于非 AKI 组和 AKI 恢复组。Kaplan-Meier 曲线表明，AKI 未恢复与较低的生存率相关（<0.001）。高乳酸（≤0.05）和犬尿氨酸水平（≤0.05）与 AKI 后肾功能未恢复相关。乳酸和犬尿氨酸预测 AKI 未恢复的曲线下面积分别为 0.693 和 0.721。高犬尿氨酸组（=0.040）和高乳酸组（=0.010）的生存率较低。
从 AKI 中恢复的患者的死亡率与未发生 AKI 的患者相当。乳酸和犬尿氨酸可能是脓毒症相关 AKI 诊断和恢复的有用生物标志物。
