尿NGAL、KIM-1联合APACHEⅡ评分预测脓毒症并发急性肾损伤患者预后的价值

    Prognostic value of urinary NGAL and KIM-1 combined with APACHEⅡ scoring in patients with sepsis complicated with acute renal injury

    • 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)评分预测脓毒症急性肾损伤(AKI)患者预后的价值。方法 选取海南西部中心医院收治的脓毒症并发AKI患者108例,根据其是否死亡分为存活组(n=72)和死亡组(n=36)。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评分对脓毒症并发AKI患者预后的价值。结果 死亡组尿NGAL(970.2±705.2 ng/mLvs 612.5±415.4 ng/mL)、KIM-1(62.6±12.4) ng/L vs(28.8±7.2) ng/L及APACHEⅡ评分(26.8±8.3)分 vs(17.90±6.20)分均明显高于存活组(P<0.05)。ROC曲线分析显示,尿NGAL、KIM-1及APACHEⅡ评分预测AKI患者死亡的最佳截取值分别为805.26 ng/mL、50.35 ng/L、23.90 分,三者联合预测脓毒症并发AKI患者死亡的曲线下面积(0.937,95%CI 0.885~0.987)、敏感度(96.3%)和特异度(88.0%)较高。结论 尿NGAL、KIM-1及APACHEⅡ评分三者联合检测在评估脓毒症并发AKI患者死亡时具有良好的预测价值,可提高脓毒症并发AKI患者预后评估的准确性。

       

      Abstract: Objective To investigate the prognostic value of urinary neutrophil gelatinase-associated lipid carrier protein (NGAL), kidney injury molecule-1 (KIM-1) combined with acute physiology and chronic health Ⅱ (APACHE Ⅱ)scoring in patients with sepsis-induced acute kidney injury (AKI). Methods A total of 108 patients with sepsis complicated with AKI admitted to Hainan Western Central Hospital were divided into the survival group (n=72) and death group (n=36) according to whether they died or not. Urinary NGAL and KIM-1 levels were measured with enzyme-linked immunosorbent assay (ELISA) and APACHE Ⅱ scores were recorded. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of urinary NGAL, KIM-1 and APACHE Ⅱ scores in patients with sepsis complicated with AKI. Results The urinary NGAL(970.2±705.2) vs (612.5±415.4), ng/mL, KIM-1(62.6±12.4) vs (28.8±7.2), ng/L and APACHE Ⅱ score(26.8±8.3) vs (17.9±6.2), score in the death group were significantly higher than those in the survival group (P<0.05). ROC curve analysis showed that the optimal cut-off values of urinary NGAL, KIM-1 and APACHEⅡ scores for predicting AKI mortality were 805.26 ng/mL, 50.35 ng/L and 23.90 points, respectively. Combined use of the three indicators had higharea under the curve (0.937, 95%CI 0.885~0.987), sensitivity (96.3%) and specificity (88.0%) in predicting AKI mortality in sepsis patients were higher. Conclusions Urinary NGAL, KIM-1 and APACHE Ⅱ scores have good predictive value in evaluating the mortality of sepsis patients complicated with AKI, and increase accuracy of prognostic evaluation in patients with sepsis complicated with AKI.

       

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