Han Suyeon, Kim Moo-Jun, Ko Ho-Joon, Lee Eu-Jin, Kim Hae-Ri, Jeon Jae-Wan, Ham Young-Rok, Na Ki-Ryang, Lee Kang-Wook, Lee Song-I, Choi Dae-Eun, Park Heyrim
Department of Nephrology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea.
Department of Nephrology, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea.
Diagnostics (Basel). 2023 Feb 18;13(4):777. doi: 10.3390/diagnostics13040777.
For reducing the high mortality rate of severe acute kidney injury (AKI) patients initiating continuous renal replacement therapy (CRRT), diagnosing sepsis and predicting prognosis are essential. However, with reduced renal function, biomarkers for diagnosing sepsis and predicting prognosis are unclear. This study aimed to assess whether C-reactive protein (CRP), procalcitonin, and presepsin could be used to diagnose sepsis and predict mortality in patients with impaired renal function initiating CRRT. This was a single-center, retrospective study involving 127 patients who initiated CRRT. Patients were divided into sepsis and non-sepsis groups according to the SEPSIS-3 criteria. Of the 127 patients, 90 were in the sepsis group and 37 were in the non-sepsis group. Cox regression analysis was performed to determine the association between the biomarkers (CRP, procalcitonin, and presepsin) and survival. CRP and procalcitonin were superior to presepsin for diagnosing sepsis. Presepsin was closely related to the estimated glomerular filtration rate (eGFR) ( = -0.251, = 0.004). These biomarkers were also evaluated as prognostic markers. Procalcitonin levels ≥3 ng/mL and CRP levels ≥31 mg/L were associated with higher all-cause mortality using Kaplan-Meier curve analysis. (log-rank test = 0.017 and = 0.014, respectively). In addition, procalcitonin levels ≥3 ng/mL and CRP levels ≥31 mg/L were associated with higher mortality in univariate Cox proportional hazards model analysis. In conclusion, a higher lactic acid, sequential organ failure assessment score, eGFR, and a lower albumin level have prognostic value to predict mortality in patients with sepsis initiating CRRT. Moreover, among these biomarkers, procalcitonin and CRP are significant factors for predicting the survival of AKI patients with sepsis-initiating CRRT.
为降低开始接受连续性肾脏替代治疗（CRRT）的重症急性肾损伤（AKI）患者的高死亡率，诊断脓毒症并预测预后至关重要。然而，随着肾功能减退，用于诊断脓毒症和预测预后的生物标志物尚不清楚。本研究旨在评估C反应蛋白（CRP）、降钙素原和可溶性髓系细胞触发受体-1（presepsin）是否可用于诊断肾功能受损且开始接受CRRT的患者的脓毒症并预测死亡率。这是一项单中心回顾性研究，纳入了127例开始接受CRRT的患者。根据脓毒症-3标准将患者分为脓毒症组和非脓毒症组。127例患者中，脓毒症组90例，非脓毒症组37例。进行Cox回归分析以确定生物标志物（CRP、降钙素原和可溶性髓系细胞触发受体-1）与生存率之间的关联。CRP和降钙素原在诊断脓毒症方面优于可溶性髓系细胞触发受体-1。可溶性髓系细胞触发受体-1与估计肾小球滤过率（eGFR）密切相关（r = -0.251，P = 0.004）。这些生物标志物也被评估为预后标志物。使用Kaplan-Meier曲线分析，降钙素原水平≥3 ng/mL和CRP水平≥31 mg/L与全因死亡率较高相关（对数秩检验分别为P = 0.017和P = 0.014）。此外，在单变量Cox比例风险模型分析中，降钙素原水平≥3 ng/mL和CRP水平≥31 mg/L与较高死亡率相关。总之，较高的乳酸水平、序贯器官衰竭评估评分、eGFR以及较低的白蛋白水平对预测开始接受CRRT的脓毒症患者的死亡率具有预后价值。此外，在这些生物标志物中，降钙素原和CRP是预测开始接受CRRT的脓毒症AKI患者生存的重要因素。
