尿NGAL、KIM-1联合APACHEⅡ评分对脓毒症急性肾损伤诊断及预后的价值
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摘要
目的:探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对脓毒症急性肾损伤(AKI)诊断及预后的价值。方法:选取我院收治的脓毒症患者154例,根据其是否发生AKI分为AKI组(n=53)和非AKI组(n=101)。53例AKI患者根据其28d的生存情况,分为存活组(n=36)和死亡组(n=17)。采用酶联免疫吸附法测定各组尿NGAL、KIM-1水平,并记录其APACHEⅡ评分。应用受试者工作特征(ROC)曲线评价尿NGAL、KIM-1及APACHEⅡ评分对AKI诊断及预后的价值。结果:AKI组尿NGAL[(753.28±540.36)pg/ml vs(456.50±381.42)ng/ml]、KIM-1[(46.37±9.12)pg/ml vs(20.54±6.34)pg/ml]及APACHEⅡ评分[(22.14±7.50)分vs(16.12±6.13)分]均明显高于非AKI组(P<0.05)。死亡组尿NGAL[(957.50±716.35)ng/ml vs (582.30±427.40)ng/ml]、KIM-1[(63.84±12.32)pg/ml vs(30.26±7.15)pg/ml]及APACHEⅡ评分[(27.60±8.24)分vs(18.37±6.38)分]均明显高于存活组(P<0.05)。ROC曲线分析显示,尿NGAL、KIM-1、APACHEⅡ评分诊断AKI的最佳截值分别为614.28ng/ml,35.78pg/ml,19.58分,三者联合诊断AKI的敏感度(95.0%)和特异度(87.0%)较好;尿NGAL、KIM-1、APACHEⅡ评分预测AKI患者死亡的最佳截值分别为793.42ng/ml,49.13pg/ml,24.63分,三者联合预测AKI患者死亡的敏感度(97.4%)和特异度(88.2%)较好。结论:尿NGAL及KIM-1是预测脓毒症患者发生AKI及预后的有效指标,与APACHEⅡ评分联合有助于提高AKI诊断和预后评估的准确性。
Objective:The value of urinary neutrophil gelatinase related lipid carrier protein(NGAL),renal injury molecule-1(KIM-1)combined with acute physiology and chronic health status score system(APACHE Ⅱ)score on the diagnosis and prognosis of acute kidney injury(AKI)of sepsis.Method:One hundred and fifty-four patients with sepsis were selected from the third People's Hospital of Hainan Province.They were divided into AKI group(n=53)and non AKI group(n=101)according to whether they had AKI.53 patients with AKI were divided into survival group(n=36)and death group(n=17)according to their 28 days survival.The levels of NGAL and KIM-1in urine of each group were measured by enzyme linked immunosorbent assay(ELISA),and the APACHE Ⅱscore was recorded.Application of receiver operating characteristic(ROC)curve to evaluate urinary NGAL,KIM-1and APACHE Ⅱscores in diagnosis and prognosis of AKI.Correlation analysis of urinary NGAL and KIM-1levels and APACHE Ⅱscore in AKI patients by Pearson correlation analysis.Result:The urine NGAL(753.28±540.36 vs 456.50±381.42,ng/ml),KIM-1(46.37±9.12 vs 20.54±6.34,pg/ml)and APACHE Ⅱ score(22.14±7.50 vs 16.12±6.13,score)in AKI group were significantly higher than those in non AKI group(P<0.05).The urine NGAL(957.50±716.35 vs 582.30±427.40,ng/ml),KIM-1(63.84±12.32 vs 30.26±7.15,pg/ml)and APACHE Ⅱscore(27.60±8.24 vs 18.37±6.38,score)in the death group were significantly higher than those in the survival group(P<0.05).The ROC curve analysis showed that the best cross-sectional value of NGAL,KIM-1and APACHEⅡscores in the diagnosis of AKI were 614.28ng/ml,35.78pg/ml,19.58 score,and the sensitivity(95.0%)and specificity(87.0%)of the three combined diagnostic AKI were better.The best cut-off values of urinary NGAL,KIM-1and APACHE Ⅱ scores in predicting the death of AKI patients were 793.42ng/ml,49.13pg/ml,24.63 score,and the sensitivity(97.4%)and specificity(88.2%)of the three combined prediction of the death of AKI were better.Correlation analysis showed that urinary NGAL and KIM-1levels in AKI patients were positively correlated with APACHEⅡscore(r=0.794,r=0.730,P<0.01).Conclusion:Urine NGAL and KIM-1are effective indicators for predicting AKI and prognosis in patients with sepsis.Combined with APACHE Ⅱscore can help improve the accuracy of AKI diagnosis and prognosis evaluation.
Objective:The value of urinary neutrophil gelatinase related lipid carrier protein(NGAL),renal injury molecule-1(KIM-1)combined with acute physiology and chronic health status score system(APACHE Ⅱ)score on the diagnosis and prognosis of acute kidney injury(AKI)of sepsis.Method:One hundred and fifty-four patients with sepsis were selected from the third People's Hospital of Hainan Province.They were divided into AKI group(n=53)and non AKI group(n=101)according to whether they had AKI.53 patients with AKI were divided into survival group(n=36)and death group(n=17)according to their 28 days survival.The levels of NGAL and KIM-1in urine of each group were measured by enzyme linked immunosorbent assay(ELISA),and the APACHE Ⅱscore was recorded.Application of receiver operating characteristic(ROC)curve to evaluate urinary NGAL,KIM-1and APACHE Ⅱscores in diagnosis and prognosis of AKI.Correlation analysis of urinary NGAL and KIM-1levels and APACHE Ⅱscore in AKI patients by Pearson correlation analysis.Result:The urine NGAL(753.28±540.36 vs 456.50±381.42,ng/ml),KIM-1(46.37±9.12 vs 20.54±6.34,pg/ml)and APACHE Ⅱ score(22.14±7.50 vs 16.12±6.13,score)in AKI group were significantly higher than those in non AKI group(P<0.05).The urine NGAL(957.50±716.35 vs 582.30±427.40,ng/ml),KIM-1(63.84±12.32 vs 30.26±7.15,pg/ml)and APACHE Ⅱscore(27.60±8.24 vs 18.37±6.38,score)in the death group were significantly higher than those in the survival group(P<0.05).The ROC curve analysis showed that the best cross-sectional value of NGAL,KIM-1and APACHEⅡscores in the diagnosis of AKI were 614.28ng/ml,35.78pg/ml,19.58 score,and the sensitivity(95.0%)and specificity(87.0%)of the three combined diagnostic AKI were better.The best cut-off values of urinary NGAL,KIM-1and APACHE Ⅱ scores in predicting the death of AKI patients were 793.42ng/ml,49.13pg/ml,24.63 score,and the sensitivity(97.4%)and specificity(88.2%)of the three combined prediction of the death of AKI were better.Correlation analysis showed that urinary NGAL and KIM-1levels in AKI patients were positively correlated with APACHEⅡscore(r=0.794,r=0.730,P<0.01).Conclusion:Urine NGAL and KIM-1are effective indicators for predicting AKI and prognosis in patients with sepsis.Combined with APACHE Ⅱscore can help improve the accuracy of AKI diagnosis and prognosis evaluation.
引文
[1]Mansuri U,Patel A,Shah H,et al.Trends and outcomes of sepsis hospitalizations complicated by acute kidney injury requiring hemodialysis[J].J Crit Care,2017,38(4):353-355.
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[3]Dey S,Karim HMR,Yunus M,et al.Relationship of on Admission Hypocalcaemia and Illness Severity as Measured by APACHE-II and SOFA Score in Intensive Care Patients[J].J Clin Diagn Res,2017,11(3):UC01-UC03.
[4]Dellinger RP,Levy MM,Rhodes A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[5]Khwaja A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-c184.
[6]Kellum JA,Prowle JR.Paradigms of acute kidney injury in the intensive care setting[J].Nat Rev Nephrol,2018,14(4):217-230.
[7]Riyuzo MC,Silveira LV,Macedo CS,et al.Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis[J].J Pediatr(Rio J),2017,93(1):28-34.
[8]Albeladi FI,Algethamy HM.Urinary Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Acute Kidney Injury,Severe Kidney Injury,and the Need for Renal Replacement Therapy in the Intensive Care U-nit[J].Nephron Extra,2017,7(2):62-77.
[9]Hwang S,Park J,Kim J,et al.Tissue expression of tubular injury markers is associated with renal function decline in diabetic nephropathy[J].J Diabetes Complications,2017,31(12):1704-1709.
[10]Bland SK,Schmiedt CW,Clark ME,et al.Expression of Kidney Injury Molecule-1in Healthy and Diseased Feline Kidney Tissue[J].Vet Pathol,2017,54(3):490-510.
[11]Rathnakar SK,Vishnu VH,Muniyappa S,et al.Accuracy and Predictability of PANC-3Scoring System over APACHEⅡin Acute Pancreatitis:A Prospective Study[J].J Clin Diagn Res,2017,11(2):PC10-PC13.
[12]池锐彬,邓宇珺,袁婕,等.尿NAG联合血清CysC预测重症患者急性肾损伤诊断和预后的临床价值[J].中华急诊医学杂志,2016,25(2):194-199.
[13]Shao X,Tian L,Xu W,et al.Diagnostic value of urinary kidney injury molecule 1for acute kidney injury:a meta-analysis[J].PLoS One,2014,9(1):e84131.
[14]Chhangani NP,Amandeep M,Choudhary S,et al.Role of acute physiology and chronic health evaluation IIscoring system in determining the severity and prognosis of critically ill patients in pediatric intensive care unit[J].Indian J Crit Care Med,2015,19(8):462-465.
[15]Zhang J,Han J,Liu J,et al.Clinical significance of novel biomarker NGAL in early diagnosis of acute renal injury[J].Exp Ther Med,2017,14(5):5017-5021.
[16]余姗姗,梁显泉,于学忠,等.中性粒细胞明胶酶相关载脂蛋白在早期诊断脓毒症合并急性肾损伤中的价值[J].中国急救医学,2017,37(3):209-215.
[17]Xie Y,Wang Q,Wang C,et al.Association between the levels of urine kidney injury molecule-1and the progression of acute kidney injury in the elderly[J].PLoS One,2017,12(2):e0171076.
[18]Pang HM,Qin XL,Liu TT,et al.Urinary kidney injury molecule-1and neutrophil gelatinase-associated lipocalin as early biomarkers for predicting vancomycin-associated acute kidney injury:aprospective study[J].Eur Rev Med Pharmacol Sci,2017,21(18):4203-4213.
[2]Sun IO,Shin SH,Cho AY,et al.Clinical significance of NGAL and KIM-1for acute kidney injury in patients with scrub typhus[J].PLoS One,2017,12(4):e0175890.
[3]Dey S,Karim HMR,Yunus M,et al.Relationship of on Admission Hypocalcaemia and Illness Severity as Measured by APACHE-II and SOFA Score in Intensive Care Patients[J].J Clin Diagn Res,2017,11(3):UC01-UC03.
[4]Dellinger RP,Levy MM,Rhodes A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[5]Khwaja A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-c184.
[6]Kellum JA,Prowle JR.Paradigms of acute kidney injury in the intensive care setting[J].Nat Rev Nephrol,2018,14(4):217-230.
[7]Riyuzo MC,Silveira LV,Macedo CS,et al.Predictive factors of mortality in pediatric patients with acute renal injury associated with sepsis[J].J Pediatr(Rio J),2017,93(1):28-34.
[8]Albeladi FI,Algethamy HM.Urinary Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Acute Kidney Injury,Severe Kidney Injury,and the Need for Renal Replacement Therapy in the Intensive Care U-nit[J].Nephron Extra,2017,7(2):62-77.
[9]Hwang S,Park J,Kim J,et al.Tissue expression of tubular injury markers is associated with renal function decline in diabetic nephropathy[J].J Diabetes Complications,2017,31(12):1704-1709.
[10]Bland SK,Schmiedt CW,Clark ME,et al.Expression of Kidney Injury Molecule-1in Healthy and Diseased Feline Kidney Tissue[J].Vet Pathol,2017,54(3):490-510.
[11]Rathnakar SK,Vishnu VH,Muniyappa S,et al.Accuracy and Predictability of PANC-3Scoring System over APACHEⅡin Acute Pancreatitis:A Prospective Study[J].J Clin Diagn Res,2017,11(2):PC10-PC13.
[12]池锐彬,邓宇珺,袁婕,等.尿NAG联合血清CysC预测重症患者急性肾损伤诊断和预后的临床价值[J].中华急诊医学杂志,2016,25(2):194-199.
[13]Shao X,Tian L,Xu W,et al.Diagnostic value of urinary kidney injury molecule 1for acute kidney injury:a meta-analysis[J].PLoS One,2014,9(1):e84131.
[14]Chhangani NP,Amandeep M,Choudhary S,et al.Role of acute physiology and chronic health evaluation IIscoring system in determining the severity and prognosis of critically ill patients in pediatric intensive care unit[J].Indian J Crit Care Med,2015,19(8):462-465.
[15]Zhang J,Han J,Liu J,et al.Clinical significance of novel biomarker NGAL in early diagnosis of acute renal injury[J].Exp Ther Med,2017,14(5):5017-5021.
[16]余姗姗,梁显泉,于学忠,等.中性粒细胞明胶酶相关载脂蛋白在早期诊断脓毒症合并急性肾损伤中的价值[J].中国急救医学,2017,37(3):209-215.
[17]Xie Y,Wang Q,Wang C,et al.Association between the levels of urine kidney injury molecule-1and the progression of acute kidney injury in the elderly[J].PLoS One,2017,12(2):e0171076.
[18]Pang HM,Qin XL,Liu TT,et al.Urinary kidney injury molecule-1and neutrophil gelatinase-associated lipocalin as early biomarkers for predicting vancomycin-associated acute kidney injury:aprospective study[J].Eur Rev Med Pharmacol Sci,2017,21(18):4203-4213.
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