Prognosis evaluation of acute kidney injury with KDIGO staging criteria and NGAL in severe sepsis patients treated with continuous blood purification / 中华急诊医学杂志

ABSTRACT

Objective To investigate the prognosis evaluation of acute kidney injury (AKI) by kidney disease staging of Improving Global Outcomes Organization (KDIGO) criteria and neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis patients treated with continuous blood purification (CBP).Methods In this prospective study, 84 severe sepsis patients treated with venous-venous CBP were selected from January 2013 to December 2014 in emergency intensive care unit of Medical University of China, Shun Yi Hospital and were divided into 3 groups based on the KDIGO staging criteria.Blood NGAL, ICU survival rate and renal function outcome of survivals were compared among groups.Results Compared with KDIGO stage 3, KDIGO stages 1 and 2 hospitalized patients had significantly lower NGAL [(453.9 ± 74.4) ng/mL vs.(789.1 ±86.8) ng/mL, P ＜0.01];Hospitalized survival rate was 92.3％ (24/26) in KDIGO stages 1 and 2 which was significantly higher than 69.0％ (40/58) in KDIGO stage 3 (P =0.026).Renal function improvement rate in KDIGO stages 1 and 2 was significantly higher than that in KDIGO stage 3 [83.3％ (20/24) vs.27.5％ (11/40), P ＜0.01].When the reliability of combination of KDIGO criteria and NGAL for prognosis evaluation was analyzed by ROC curve, the area under curve of survival was 0.703 (95％ confidence interval 0.648-0.759, P ＜0.01) and area under curve of renal function improvement was 0.679 (95％ confidence interval 0.627-0.731, P ＜ 0.01).Conclusions In severe sepsis patients complicated with AKI, CBP in KDIGO stages 1 and 2 might improve survival rate and renal function of sepsis patients.Combination of KDIGO criteria and NGAL maybe acted as an indicator of the prognosis in severe sepsis patients with complication of AKI.