Jung Chan-Young, Jung Jiyun, Lim Jeong-Hoon, Paek Jin Hyuk, Kim Kipyo, Ban Tae Hyun, Park Jae Yoon, Kim Hyosang, Kim Yong Chul, Baek Chung Hee
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clinical Trial Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Kidney Res Clin Pract. 2024 Jul;43(4):433-443. doi: 10.23876/j.krcp.23.321. Epub 2024 Jun 13.
Identifying risk factors and improving prognostication for mortality among patients with sepsis-associated acute kidney injury (AKI) undergoing continuous kidney replacement therapy (CKRT) is important in improving the adverse prognosis of this patient population. This study aimed to compare the prognostic value of existing systemic inflammation biomarkers and determine the optimal systemic inflammation biomarker in patients with sepsis-associated AKI receiving CKRT.
This multi-center, retrospective, observational cohort study included 1,500 patients with sepsis-associated AKI treated with intensive care and CKRT. The main predictor was a panel of 13 different systemic inflammation biomarkers. The primary outcome was 28-day mortality after CKRT initiation. Secondary outcomes included 90-day mortality after CKRT initiation, CKRT duration, kidney replacement therapy dependence at discharge, and lengths of intensive care unit (ICU) and hospital stays.
When added to the widely accepted Acute Physiology and Chronic Health Evaluation II score, platelet-to-albumin ratio (PAR) and neutrophil-platelet score (NPS) had the highest improvements in prognostication of 28-day mortality, where the corresponding increases in C-statistic were 0.01 (95% confidence interval [CI], 0.00-0.02) and 0.02 (95% CI, 0.01-0.03). Similar findings were observed for 90-day mortality. The 28- and 90-day mortality rates were significantly lower for the higher PAR and NPS quartiles. These associations remained significant even after adjustment for potential confounding variables in multivariable Cox proportional hazards models.
Of the available systemic inflammation biomarkers, the addition of PAR or NPS to conventional ICU prediction models improved the prognostication of patients with sepsis-associated AKI receiving intensive care and CKRT.
识别脓毒症相关性急性肾损伤（AKI）患者接受持续肾脏替代治疗（CKRT）时的死亡风险因素并改善预后评估，对于改善该患者群体的不良预后至关重要。本研究旨在比较现有全身炎症生物标志物的预后价值，并确定接受CKRT的脓毒症相关性AKI患者的最佳全身炎症生物标志物。
这项多中心、回顾性、观察性队列研究纳入了1500例接受重症监护和CKRT治疗的脓毒症相关性AKI患者。主要预测指标是一组13种不同的全身炎症生物标志物。主要结局是CKRT开始后28天的死亡率。次要结局包括CKRT开始后90天的死亡率、CKRT持续时间、出院时对肾脏替代治疗的依赖性以及重症监护病房（ICU）和住院时间。
当将血小板与白蛋白比值（PAR）和中性粒细胞与血小板评分（NPS）添加到广泛接受的急性生理与慢性健康状况评分II中时，对28天死亡率的预后评估改善最大，其中C统计量的相应增加分别为0.01（95%置信区间[CI]，0.00 - 0.02）和0.02（95%CI，0.01 - 0.03）。90天死亡率也有类似发现。PAR和NPS四分位数较高的患者，其28天和90天死亡率显著较低。即使在多变量Cox比例风险模型中对潜在混杂变量进行调整后，这些关联仍然显著。
在可用的全身炎症生物标志物中，将PAR或NPS添加到传统的ICU预测模型中可改善接受重症监护和CKRT的脓毒症相关性AKI患者的预后评估。
