Li Fang, Tian Xue, Wang Lu, Wu Ling-Pei, Liu Xiao, Peng Hong-Ying
Demartment of Nerhrology, The Affiliated Hospital of Guizhou Medical University, Guizhou 550004, China.
Department of Nephrology, The Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang 550004, China.
Exp Gerontol. 2024 Dec;198:112634. doi: 10.1016/j.exger.2024.112634. Epub 2024 Nov 25.
The aim of this study is to investigate the early prognostic efficacy of plasma soluble urokinase-type plasminogen activator receptor (suPAR), soluble tumor necrosis factor receptor 1 (sTNFR1), and soluble tumor necrosis factor receptor 2 (sTNFR2) in complicated acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19), and to analyze the relevant factors contributing to complicated AKI in these patients.
Patients with COVID-19 hospitalized at the Affiliated Baiyun Hospital of Guizhou Medical University from March 2022 to March 2024 were selected as study participants. A total of 589 patients met the inclusion and exclusion criteria, 68 patients complicated with AKI were classified as AKI group, and the remaining 521 cases were divided into proportion sampling method and randomly selected 200 samples, which were classified as non-AKI group. Additionally, 50 healthy controls were enrolled as the control group. Logistic regression analysis was conducted to identify the relevant factors associated with complicated AKI in patients with COVID-19. Receiver operating characteristic (ROC) curves were plotted to evaluate the prognostic efficacy of plasma suPAR, sTNFR1, and sTNFR2 indicators for complicated AKI in patients with COVID-19.
Among the patients with COVID-19 in the AKI group, 43 were males (63.20 %), with a median age of 79.00 (interquartile range: 75.00, 83.00) years, while the non-AKI group comprised 83 males (41.50 %), with a median age of 73.00 (interquartile range: 60.00, 80.75) years. Comparison of the sex and age between the two groups indicated that males and elderly patients had increased risks of complicated AKI (P < 0.05). Plasma levels of suPAR, sTNFR1, and sTNFR2 in the AKI group were significantly higher than those in the non-AKI group (P < 0.05). Logistic regression analysis indicated that suPAR and sTNFR2 were independent factors influencing complicated AKI in patients with COVID-19 (P < 0.05). The ROC curve for a single indicator showed that suPAR had the highest prognostic efficacy for complicated AKI, with an area under the curve (AUC) of 0.813, a sensitivity of 79.4 %, and a specificity of 74.0 %. The combined use of suPAR and sTNFR2 for risk assessment yielded the highest AUC of 0.838, with a sensitivity of 66.2 % and a specificity of 87.5 %. The combined risk assessment using all three indicators (suPAR, sTNFR1, and sTNFR2) had an AUC of 0.837, with a sensitivity of 64.7 % and a specificity of 89.0 %.
Elderly patients had increased risks of complicated AKI. Indicators such as suPAR, sTNFR1, and sTNFR2 can assist in assessing the risk in patients with COVID-19 complicated AKI, with suPAR demonstrating the highest prognostic efficacy as a single indicator. The combined detection of suPAR, sTNFR1, and sTNFR2 offers greater prognostic value than using any single indicator.
本研究旨在探讨血浆可溶性尿激酶型纤溶酶原激活物受体（suPAR）、可溶性肿瘤坏死因子受体1（sTNFR1）和可溶性肿瘤坏死因子受体2（sTNFR2）对2019冠状病毒病（COVID-19）患者并发急性肾损伤（AKI）的早期预后评估价值，并分析这些患者并发AKI的相关因素。
选取2022年3月至2024年3月在贵州医科大学附属白云医院住院的COVID-19患者作为研究对象。共有589例患者符合纳入和排除标准，其中68例并发AKI的患者被分为AKI组，其余521例采用比例抽样法随机抽取200例作为非AKI组。另外，纳入50例健康对照作为对照组。采用Logistic回归分析确定COVID-19患者并发AKI的相关因素。绘制受试者工作特征（ROC）曲线，评估血浆suPAR、sTNFR1和sTNFR2指标对COVID-19患者并发AKI的预后评估价值。
AKI组COVID-19患者中，男性43例（63.20%），中位年龄79.00岁（四分位间距：75.00，83.00岁）；非AKI组男性83例（41.50%），中位年龄73.00岁（四分位间距：60.00，80.75岁）。两组性别和年龄比较显示，男性和老年患者并发AKI的风险增加（P<0.05）。AKI组血浆suPAR、sTNFR1和sTNFR2水平显著高于非AKI组（P<0.05）。Logistic回归分析表明，suPAR和sTNFR2是影响COVID-19患者并发AKI的独立因素（P<0.05）。单指标ROC曲线显示，suPAR对并发AKI的预后评估价值最高，曲线下面积（AUC）为0.813，灵敏度为79.4%，特异度为74.0%。联合使用suPAR和sTNFR2进行风险评估时AUC最高，为0.838，灵敏度为66.2%，特异度为87.5%。使用所有三个指标（suPAR、sTNFR1和sTNFR2）联合进行风险评估的AUC为0.837，灵敏度为64.7%，特异度为89.0%。
老年患者并发AKI的风险增加。suPAR、sTNFR1和sTNFR2等指标可辅助评估COVID-19并发AKI患者的风险，其中suPAR作为单指标的预后评估价值最高。联合检测suPAR、sTNFR1和sTNFR2比单一指标具有更高的预后评估价值。
