尿中性粒细胞明胶酶相关载脂蛋白、肾损伤分子 1 和血管紧张素原联合用于脓毒症急性肾损伤的早期诊断和死亡预测。
Combination of Urinary Neutrophil Gelatinase-associated Lipocalin, Kidney Injury Molecular-1, and Angiotensinogen for the Early Diagnosis and Mortality Prediction of Septic Acute Kidney Injury.
机构信息
Department of Critical Care Medicine, Dangyang Renmin Hospital of Hubei Province, Yichang, 444100, China.
Department of Critical Care Medicine, The First College of Clinical Medical Science, China Three Gorges University (Yichang Central People's Hospital), Yichang, 443000, China.
出版信息
Comb Chem High Throughput Screen. 2024;27(7):1033-1045. doi: 10.2174/0113862073263073231011060142.
BACKGROUND
Acute kidney injury (AKI) is one of the most severe complications of sepsis. This study was conducted to analyze the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary kidney injury molecular-1 (uKIM-1), and urinary angiotensinogen (uAGT) in the early diagnosis and mortality prediction of septic AKI.
METHODS
The prospective study enrolled 80 sepsis patients in the ICU and 100 healthy individuals and divided patients into an AKI group and a non-AKI group. uNGAL, uKIM-1, uAGT, serum creatinine/procalcitonin/C-reaction protein, and other indicators were determined, and clinical prediction scores were recorded. The sensitivity and specificity of uNGAL, uKIM-1, and uAGT in diagnosis and mortality prediction were analyzed by the receiver operator characteristic (ROC) curve and the area under the curve (AUC).
RESULTS
uNGAL, uKIM-1, and uAGT levels were higher in sepsis patients than healthy controls, higher in AKI patients than non-AKI patients, and higher in AKI-2 and AKI-3 patients than AKI-1 patients. At 0 h after admission, the combined efficacy of three indicators in septic AKI diagnosis (ROC-AUC: 0.770; sensitivity: 82.5%; specificity: 70.0%) was better than a single indicator. At 24 h, uNGAL, uKIM-1, and uAGT levels were higher in sepsis non-survivals than survivals and higher in septic AKI non-survivals than septic AKI survivals. The combined efficacy of three indicators in the prediction of sepsis/septic AKI mortality (ROC-AUC: 0.828/0.847; sensitivity: 71.4%/100.0%; specificity: 82.7%/66.7%) was better than a single indicator.
CONCLUSION
uNGAL, uKIM-1, and uAGT levels were increased in septic AKI, and their combination helped the early diagnosis and mortality prediction.
背景
急性肾损伤（AKI）是脓毒症最严重的并发症之一。本研究旨在分析尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）、尿肾损伤分子-1（uKIM-1）和尿血管紧张素原（uAGT）在脓毒症 AKI 的早期诊断和死亡率预测中的作用。
方法
前瞻性研究纳入 ICU 中的 80 例脓毒症患者和 100 例健康对照者，将患者分为 AKI 组和非 AKI 组。测定 uNGAL、uKIM-1、uAGT、血清肌酐/降钙素原/C 反应蛋白等指标，并记录临床预测评分。采用受试者工作特征（ROC）曲线和曲线下面积（AUC）分析 uNGAL、uKIM-1 和 uAGT 在诊断和死亡率预测中的敏感性和特异性。
结果
脓毒症患者的 uNGAL、uKIM-1 和 uAGT 水平高于健康对照者，AKI 患者高于非 AKI 患者，AKI-2 和 AKI-3 患者高于 AKI-1 患者。入院后 0 h，三项指标联合诊断脓毒症 AKI 的效能（ROC-AUC：0.770；敏感性：82.5%；特异性：70.0%）优于单项指标。24 h 时，脓毒症死亡者的 uNGAL、uKIM-1 和 uAGT 水平高于存活者，脓毒症 AKI 死亡者的 uNGAL、uKIM-1 和 uAGT 水平高于脓毒症 AKI 存活者。三项指标联合预测脓毒症/脓毒症 AKI 死亡率的效能（ROC-AUC：0.828/0.847；敏感性：71.4%/100.0%；特异性：82.7%/66.7%）优于单项指标。
结论
uNGAL、uKIM-1 和 uAGT 水平在脓毒症 AKI 中升高，联合检测有助于早期诊断和死亡率预测。
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