Prediction of acute kidney injury complicated by sepsis with sTREM-1 and NGAL as early marker / 中华肾脏病杂志

ABSTRACT

Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis.Methods A total of 141 eligible patients were enrolled in this prospective study.Blood and urine samples were collected at different time points as soon as sepsis was diagnosed.The concentrations of serum creatinine (Scr),urine sTREM-1 and NGAL were measured.According to AKI criteria,patients were divided into the AKI group and non-AKI group.Dynamic changes of levels of Scr,urine sTREM-1 and NGAL were observed in two groups.The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL.Results Among 141 septic patients,44 (31.2％) cases had concomitant AKI.Twenty four hours after sepsis diagnosed,the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6± 15.3) μmol/L,P ＜ 0.05],which met the diagnostic criteria of AKI.In the AKI group,urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9± 14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L,both P ＜ 0.05].And at the following time points,urinary concentrations of sTREM-1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P ＜ 0.05).At 8 h time point,thearea under the curve of urine sTREM-1 was 0.877 (95％CI 0.756-0.914),the sensitivity was 89.1％ and specificity was 82.0％ with a cutoff value of 70 ng/L.At 8 h time point,the area under the curve of urine NGAL was 0.862 (95％ CI 0.703-0.958),the sensitivity was 87.4％ and specificity was 85.5％ with a cutoff value of 90 μg/L.Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr.Therefore,urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.