Kumari Nidhi, Parashar Samiksha, Giri Manoj, Tripathi Manoj, Kumar Virendra, Kumar Suraj
Department of Anaesthesiology, MRA Medical College, Ambedkar Nagar, Uttar Pradesh, India.
Department of Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Int J Crit Illn Inj Sci. 2024 Oct-Dec;14(4):197-202. doi: 10.4103/ijciis.ijciis_66_24. Epub 2024 Dec 23.
Sepsis-induced acute kidney injury (AKI) is difficult to prevent because most patients are diagnosed after they develop it. Standard serum and urine creatinine levels are insensitive and nonspecific for detecting kidney injury in its early stages. Glutathione S-transferase (GST) has received little attention as a biomarker in AKI.
This study included 65 adult patients with sepsis who developed oliguria within 72 h of admission. Baseline serum creatinine values were recorded at least 1 month before or after intensive care unit (ICU) admission. The clinical endpoints were defined as the occurrence of advanced AKI stages 2 or 3 according to the KDIGO classification. Serum creatinine and urinary GST levels were measured every 6 h from admission until 72 h postoliguria development. The primary objective was to assess the correlation between urinary GST and serum creatinine levels in patients with sepsis-induced AKI.
Among the 65 patients, 13 (20%) progressed to AKI Grade I, while 52 (80%) progressed to AKI Grade II or III. Both groups exhibited an increasing trend in serum creatinine and urinary GST levels up to 72 h. Significant mean differences between the two AKI groups were observed at 48 and 72 h for serum creatinine ( = 0.021 and = 0.007, respectively) and at 18 h for urinary GST levels ( = 0.044).
Urinary GST levels demonstrated an earlier elevation than serum creatinine levels in critically ill sepsis patients, underscoring their utility as a valuable tool for the early diagnosis and predicting AKI following admission to the ICU.
脓毒症诱导的急性肾损伤（AKI）难以预防，因为大多数患者在发病后才被诊断出来。标准的血清和尿肌酐水平在检测早期肾损伤时不敏感且不具特异性。谷胱甘肽S-转移酶（GST）作为AKI的生物标志物很少受到关注。
本研究纳入了65例成年脓毒症患者，这些患者在入院72小时内出现少尿。在重症监护病房（ICU）入院前或入院后至少1个月记录基线血清肌酐值。临床终点根据KDIGO分类定义为进展至2期或3期的晚期AKI。从入院到少尿发生后72小时，每6小时测量一次血清肌酐和尿GST水平。主要目的是评估脓毒症诱导的AKI患者尿GST与血清肌酐水平之间的相关性。
在65例患者中，13例（20%）进展为I级AKI，而52例（80%）进展为II级或III级AKI。两组患者血清肌酐和尿GST水平在72小时内均呈上升趋势。血清肌酐在48小时和72小时时，两组AKI患者之间存在显著的平均差异（分别为P = 0.021和P = 0.007），尿GST水平在18小时时存在显著差异（P = 0.044）。
在重症脓毒症患者中，尿GST水平比血清肌酐水平升高得更早，这突出了其作为ICU入院后早期诊断和预测AKI的有价值工具的作用。
