Prognostic value of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin on early continuous renal replacement therapy in sepsis patients with acute kidney injury

doi:10.3877/cma.j.issn.1674-6880.2016.04.008

Abstract

Abstract:

Objective

To evaluate the prognostic value of kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) on early continuous renal replacement therapy (CRRT) in sepsis patients with acute kidney injury (AKI).

Methods

A total of 159 sepsis patients with AKI in the People's Hospital in Wenzhou from July 2012 to November 2015 were divided into the non-CRRT group (92 cases) and CRRT group (67 cases). Within 24 hours after the diagnosis, the urine samples were collected and the urinary KIM-1 and NGAL levels were measured by enzyme-linked immunosorbent assay. At the same time, the general data of the two groups were compared and the influence factors related to sepsis patients with AKI undergoing early CRRT were analyzed by Logistic regression. The receiver operating characteristic (ROC) was performed to evaluate the early predictive value of urinary KIM-1 and NGAL in septic AKI patients with CRRT.

Results

The age [(65 ± 18) vs.(77 ± 11) years, t=26.380, P<0.001], abdominal infection [8/92 vs. 23/67, χ²=16.228, P<0.001], limb skin and soft-tissue infections [19/92 vs. 2/67, χ²=10.556, P<0.001], coronary heart disease [46/92 vs. 50/67, χ²=9.828, P=0.002], diabetes [24/92 vs. 38/67, χ²=15.289, P<0.001], chronic cardiac insufficiency [36/92 vs. 52/67, χ²=23.229, P<0.001], endotracheal intubation >48 h [32/92 vs. 35/67, χ²=5.239, P=0.024], acute physiology and chronic health evaluation (APACHE) Ⅱscores [16 ± 6 vs. 22 ± 5, t=40.671, P<0.001], KIM-1 [(17 ± 4) ng·L^-1·Cr^-1 vs. (29±19) ng·L^-1·Cr^-1, t=34.849, P<0.001] and NGAL [(5.7 ± 1.4) ng·L^-1·Cr^-1 vs. (7.7 ± 1.6) ng·L^-1·Cr^-1, t=65.483, P<0.001] all showed singificant differences between the non-CRRT group and CRRT group. Logistic regression also showed that diabetes, chronic cardiac insufficiency, APACHE Ⅱ score >18, KIM-1 >21.0 ng·L^-1·Cr^-1 and NGAL >6.5 ng·L^-1·Cr^-1 were related factors in sepsis patients with AKI undergoing CRRT. Meanwhile, the area under curve (AUC) in ROC of KIM-1, NGAL and combination of the two for early CRRT were 0.783 (95%CI: 0.702-0.864, P<0.05), 0.819 (95%CI: 0.753-0.886, P<0.05) and 0.809 (95%CI: 0.730-0.882, P<0.05), respectively. The Youden index of KIM-1 and NGAL were 0.465, 0.502, and after the combination, the Youden index was up to 0.603.

Conclusions

Urinary NGAL and KIM-1 have a certain predictive value on early CRRT in sepsis patients with AKI. If both indices were joint detection, the accuracy of prediction will be improved.

Key words: Sepsis, Acute kidney injury, Kidney injury molecule-1, Neutrophil gelatinase-associated lipocalin, Continuous renal replacement therapy

Jianguo Xu, Xianguan Jin, Yu Li. Prognostic value of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin on early continuous renal replacement therapy in sepsis patients with acute kidney injury[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(04): 250-255.

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Figures/Tables 3

References 13

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组别	例数	性别（例，男/女）	年龄（岁，±s）	病因分类[例（%）]					基础疾病[例（%）]
组别	例数	性别（例，男/女）	年龄（岁，±s）	肺部感染	腹腔感染	胆道感染	尿路感染	四肢皮肤软组织感染	冠心病	高血压	糖尿病	慢性心功能不全
非CRRT组	92	51/41	65 ± 18	40（43.5）	8（8.7）	13（14.1）	12（13.0）	19（20.7）	46（50.0）	66（71.7）	24（26.1）	36（39.1）
CRRT组	67	44/23	77 ± 11	28（41.8）	23（34.3）	9（13.4）	5（7.1）	2（3.0）	50（74.6）	40（59.7）	38（56.7）	52（77.6）
t/χ²值	?	1.689	26.380	0.045	16.228	0.016	1.264	10.556	9.828	2.528	15.289	23.229
P值	?	0.252	<0.001	0.872	<0.001	1.000	0.308	0.001	0.002	0.127	<0.001	<0.001
组别	例数	气管插管>48 h[例（%）]	深静脉导管>48 h[例（%）]	导尿管>48 h[例（%）]	尿量（ml·h^-1· kg^-1，±s）	平均动脉压（mmHg，±s）	心率（次/min，±s）
非CRRT组	92	32（34.8）	47（51.1）	68（73.9）	1.4 ± 0.5	81 ± 17	99 ± 22
CRRT组	67	35（52.2）	32（47.8）	34（50.7）	1.3 ± 0.4	83 ± 17	96 ± 21
t/χ²值	?	5.239	0.172	0.970	1.200	0.686	1.070
P值	?	0.024	0.749	0.349	0.275	0.409	0.302
组别	例数	休克指数（±s）	肌酐（μmol/L，±s）	白细胞（× 10⁹/L，±s）	APACHEⅡ评分（分，±s）	KIM-1（ng·L^-1·Cr^-1，±s）	NGAL（ng·L^-1· Cr^-1，±s）
非CRRT组	92	1.0 ± 0.3	127 ± 29	14.9 ± 3.0	16 ± 6	17 ± 4	5.7 ± 1.4
CRRT组	67	0.9 ± 0.3	133 ± 33	15.4 ± 2.4	22 ± 5	29 ± 19	7.7 ± 1.6
t/χ²值	?	0.133	1.571	1.231	40.671	34.849	65.483
P值	?	0.715	0.212	0.269	<0.001	<0.001	<0.001

组别	例数	性别（例，男/女）	年龄（岁，±s）	病因分类[例（%）]					基础疾病[例（%）]
组别	例数	性别（例，男/女）	年龄（岁，±s）	肺部感染	腹腔感染	胆道感染	尿路感染	四肢皮肤软组织感染	冠心病	高血压	糖尿病	慢性心功能不全
非CRRT组	92	51/41	65 ± 18	40（43.5）	8（8.7）	13（14.1）	12（13.0）	19（20.7）	46（50.0）	66（71.7）	24（26.1）	36（39.1）
CRRT组	67	44/23	77 ± 11	28（41.8）	23（34.3）	9（13.4）	5（7.1）	2（3.0）	50（74.6）	40（59.7）	38（56.7）	52（77.6）
t/χ²值	?	1.689	26.380	0.045	16.228	0.016	1.264	10.556	9.828	2.528	15.289	23.229
P值	?	0.252	<0.001	0.872	<0.001	1.000	0.308	0.001	0.002	0.127	<0.001	<0.001
组别	例数	气管插管>48 h[例（%）]	深静脉导管>48 h[例（%）]	导尿管>48 h[例（%）]	尿量（ml·h^-1· kg^-1，±s）	平均动脉压（mmHg，±s）	心率（次/min，±s）
非CRRT组	92	32（34.8）	47（51.1）	68（73.9）	1.4 ± 0.5	81 ± 17	99 ± 22
CRRT组	67	35（52.2）	32（47.8）	34（50.7）	1.3 ± 0.4	83 ± 17	96 ± 21
t/χ²值	?	5.239	0.172	0.970	1.200	0.686	1.070
P值	?	0.024	0.749	0.349	0.275	0.409	0.302
组别	例数	休克指数（±s）	肌酐（μmol/L，±s）	白细胞（× 10⁹/L，±s）	APACHEⅡ评分（分，±s）	KIM-1（ng·L^-1·Cr^-1，±s）	NGAL（ng·L^-1· Cr^-1，±s）
非CRRT组	92	1.0 ± 0.3	127 ± 29	14.9 ± 3.0	16 ± 6	17 ± 4	5.7 ± 1.4
CRRT组	67	0.9 ± 0.3	133 ± 33	15.4 ± 2.4	22 ± 5	29 ± 19	7.7 ± 1.6
t/χ²值	?	0.133	1.571	1.231	40.671	34.849	65.483
P值	?	0.715	0.212	0.269	<0.001	<0.001	<0.001

危险因素	回归系数	标准误	Wald值	P值	优势比	95%置信区间
危险因素	回归系数	标准误	Wald值	P值	优势比	下限	上限
年龄	-0.767	0.781	0.966	0.326	0.464	0.101	2.144
腹腔感染	1.188	0.776	2.347	0.126	3.281	0.717	15.003
四肢皮肤软组织感染	-2.653	1.395	3.615	0.057	0.070	0.005	1.085
冠心病	1.125	0.823	1.870	0.171	3.081	0.614	15.454
糖尿病	1.829	0.793	5.314	0.021	6.227	1.315	29.480
慢性心功能不全	4.769	1.096	18.926	<0.001	117.751	13.739	1009.213
气管插管	0.939	0.632	2.208	0.137	2.558	0.741	8.832
少尿	0.874	1.593	0.301	0.583	2.396	0.105	54.430
休克指数>1.0	0.771	0.690	1.250	0.264	2.163	0.560	8.359
血肌酐>93 μmol/L	1.006	1.188	0.717	0.397	2.735	0.266	28.088
血白细胞>12 × 10⁹/L	1.024	0.897	1.305	0.253	2.786	0.480	16.155
APACHEⅡ评分>18分	2.950	0.941	9.818	0.002	19.099	3.018	120.867
KIM-1>21.0 ng·L^-1·Cr^-1	1.791	0.729	6.032	0.014	5.995	1.436	25.032
NGAL>6.5 ng·L^-1· Cr^-1	1.837	0.691	7.062	0.008	6.279	1.620	24.340

危险因素	回归系数	标准误	Wald值	P值	优势比	95%置信区间
危险因素	回归系数	标准误	Wald值	P值	优势比	下限	上限
年龄	-0.767	0.781	0.966	0.326	0.464	0.101	2.144
腹腔感染	1.188	0.776	2.347	0.126	3.281	0.717	15.003
四肢皮肤软组织感染	-2.653	1.395	3.615	0.057	0.070	0.005	1.085
冠心病	1.125	0.823	1.870	0.171	3.081	0.614	15.454
糖尿病	1.829	0.793	5.314	0.021	6.227	1.315	29.480
慢性心功能不全	4.769	1.096	18.926	<0.001	117.751	13.739	1009.213
气管插管	0.939	0.632	2.208	0.137	2.558	0.741	8.832
少尿	0.874	1.593	0.301	0.583	2.396	0.105	54.430
休克指数>1.0	0.771	0.690	1.250	0.264	2.163	0.560	8.359
血肌酐>93 μmol/L	1.006	1.188	0.717	0.397	2.735	0.266	28.088
血白细胞>12 × 10⁹/L	1.024	0.897	1.305	0.253	2.786	0.480	16.155
APACHEⅡ评分>18分	2.950	0.941	9.818	0.002	19.099	3.018	120.867
KIM-1>21.0 ng·L^-1·Cr^-1	1.791	0.729	6.032	0.014	5.995	1.436	25.032
NGAL>6.5 ng·L^-1· Cr^-1	1.837	0.691	7.062	0.008	6.279	1.620	24.340

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