Geriatric Diseases Institute of Chengdu, Department of Clinical Laboratory, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China.
West China School of Medicine, West China Hospital Sichuan University, Chengdu, Sichuan Province, China.
Cytokine. 2024 Dec;184:156798. doi: 10.1016/j.cyto.2024.156798. Epub 2024 Nov 1.
Acute kidney injury (AKI) is common in septic patients and strongly associated with adverse outcomes. The pathophysiology of AKI in septic patients remains elusive, and detection of patients at risk of AKI or at risk of progression to severe and persistent AKI is critical for timely and adequate support measures, including mitigating further renal damage. Therefore, identification of biomarkers associated with septic-associated AKI that contribute to improve septic AKI is an area of intensive research.
A total of 116 consecutive patients with sepsis were categorized into two groups (AKI and non-AKI) based on the occurrence of AKI within 24 h of admission to the intensive care unit (ICU). Serum levels of soluble TLR2 (sTLR2), as well as biomarkers such as interleukin(IL)-6, IL-22, IL-10, creatinine, urea, procalcitonin, hypersensitive C-reactive protein (hs-CRP), and D-Dimer (D2), were measured within 24 h after ICU admission. Demographic and clinical characteristics including sequential organ failure assessment (SOFA) scores and acute physiology and chronic health evaluation II (APACHE II) scores were recorded. Logistic regression analysis was conducted to identify potential predictive biomarkers. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimal model for predicting septic-associated AKI.
Patients in the AKI group exhibited significantly higher serum concentrations of IL-6, IL-10, sTLR2, creatinine, urea, hs-CRP, procalcitonin, D2 and lower serum albumin concentrations as well as higher APACHE II scores compared to those in the non-AKI group. Logistic regression analysis revealed that APACHE II scores, log10-transformed sTLR2 concentration, creatinine and D2 concentration were valuable predictors of AKI among septic patients. ROC curves demonstrated that log10-transformed sTLR2 concentration exhibited comparable predictive value to creatinine in determining the incidence of sepsis-associated AKI. The model with variables of APACHE II score, Log10-transformed serum TLR2 concentration, creatinine and D2 concentration yielded the greatest area under the curve of 0.863.
Elevated levels of sTLR2 in early-stage of septic patients may serve as a promising novel biomarker for predicting sepsis-associated AKI.
急性肾损伤（AKI）在脓毒症患者中很常见，与不良预后密切相关。脓毒症患者 AKI 的病理生理学仍然难以捉摸，因此，检测发生 AKI 风险或进展为严重和持续 AKI 风险的患者对于及时和充分的支持措施至关重要，包括减轻进一步的肾损伤。因此，确定与脓毒症相关 AKI 相关的生物标志物，以改善脓毒症 AKI，是一个研究热点。
本研究共纳入了 116 例连续的脓毒症患者，根据入住重症监护病房（ICU）后 24 小时内是否发生 AKI 将其分为 AKI 组和非 AKI 组。在入住 ICU 后 24 小时内测量血清可溶性 TLR2（sTLR2）水平以及白细胞介素（IL）-6、IL-22、IL-10、肌酐、尿素、降钙素原、超敏 C 反应蛋白（hs-CRP）和 D-二聚体（D2）等生物标志物。记录患者的人口统计学和临床特征，包括序贯器官衰竭评估（SOFA）评分和急性生理学和慢性健康评估 II（APACHE II）评分。采用逻辑回归分析确定潜在的预测生物标志物。采用受试者工作特征（ROC）曲线分析确定预测脓毒症相关 AKI 的最佳模型。
AKI 组患者的血清 IL-6、IL-10、sTLR2、肌酐、尿素、hs-CRP、降钙素原、D2 浓度显著升高，血清白蛋白浓度显著降低，APACHE II 评分显著高于非 AKI 组。逻辑回归分析显示，APACHE II 评分、对数转换 sTLR2 浓度、肌酐和 D2 浓度是脓毒症患者 AKI 的有价值的预测指标。ROC 曲线显示，对数转换 sTLR2 浓度在预测脓毒症相关 AKI 方面与肌酐具有相当的预测价值。包含 APACHE II 评分、血清 TLR2 浓度对数转换、肌酐和 D2 浓度的变量模型曲线下面积最大，为 0.863。
脓毒症患者早期 sTLR2 水平升高可能是预测脓毒症相关 AKI 的一种有前途的新型生物标志物。
