Lee Gi-Beop, Lee Ji Won, Yoon Se-Hee, Hwang Won Min, Yun Sung-Ro, Koh Dong Hoon, Park Yohan
Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Republic of Korea.
Department of Urology, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Republic of Korea.
Kidney Res Clin Pract. 2024 Jul;43(4):457-468. doi: 10.23876/j.krcp.23.301. Epub 2024 Jun 11.
The reliability of presepsin as a biomarker of sepsis may be reduced in patients with acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT). This study analyzed the utility of plasma presepsin values in predicting mortality in patients with AKI requiring CKRT, particularly those with sepsis-associated AKI.
This single-center retrospective study included 57 patients who underwent CKRT, with plasma presepsin measurements, from April 2022 to March 2023; 35 had sepsis-associated AKI. The predictive values of plasma presepsin, as well as Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, for 28-day mortality were analyzed using receiver operating characteristic curves. Multivariate Cox regression analysis was performed to identify risk factors for 28-day mortality in the sepsis-associated AKI subgroup.
Overall, plasma presepsin showed a lower area under the curve value (0.636; 95% confidence interval [CI], 0.491-0.781) than the APACHE II (0.663; 95% CI, 0.521-0.804) and SOFA (0.731; 95% CI, 0.599-0.863) scores did. However, in sepsis-associated AKI, the area under the curve increased to 0.799 (95% CI, 0.653-0.946), which was higher than that of the APACHE II (0.638; 95% CI, 0.450-0.826) and SOFA (0.697; 95% CI, 0.519-0.875) scores. In the multivariate Cox regression analysis, a high presepsin level was an independent risk factor for 28-day mortality in sepsis-associated AKI (hazard ratio, 3.437; p = 0.03).
Presepsin is a potential prognostic marker in patients with sepsis-associated AKI requiring CKRT.
对于需要持续肾脏替代治疗（CKRT）的急性肾损伤（AKI）患者， presepsin作为脓毒症生物标志物的可靠性可能会降低。本研究分析了血浆 presepsin值在预测需要CKRT的AKI患者，特别是脓毒症相关性AKI患者死亡率方面的效用。
这项单中心回顾性研究纳入了2022年4月至2023年3月期间接受CKRT并测量血浆 presepsin的57例患者；35例患有脓毒症相关性AKI。使用受试者工作特征曲线分析血浆 presepsin以及急性生理与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）评分对28天死亡率的预测价值。对脓毒症相关性AKI亚组进行多变量Cox回归分析，以确定28天死亡率的危险因素。
总体而言，血浆 presepsin的曲线下面积值（0.636；95%置信区间[CI]，0.491 - 0.781）低于APACHE II（0.663；95%CI，0.521 - 0.804）和SOFA（0.731；95%CI，0.599 - 0.863）评分。然而，在脓毒症相关性AKI中，曲线下面积增加到0.799（95%CI，0.653 - 0.946），高于APACHE II（0.638；95%CI，0.450 - 0.826）和SOFA（0.697；95%CI，0.519 - 0.875）评分。在多变量Cox回归分析中，高 presepsin水平是脓毒症相关性AKI患者28天死亡率的独立危险因素（风险比，3.437；p = 0.03）。
Presepsin是需要CKRT的脓毒症相关性AKI患者的潜在预后标志物。
