A Prospective Study on the Evaluation Method about the Biomarkers of Systemic Inflammatory Response Syndrome (Sepsis)Complicated with Acute Kidney Injury(AKI) During Continuous Renal Replacement Therapy(CRRT) / 医学研究杂志

ABSTRACT

Objective To evaluate the predictive value of serum cystatin C (sCys C),urinary neutrophil gelatinase associated lipocalin(uNGAL) and interleukin-18 (uIL-18)in early diagnosis of continuous renal replacement therapy (CRRT) in systemic inflammatory response syndrome (Sepsis) complicated with acute kidney injury (AKI) and difference post-replacement volume in CRRT.Methods Total of 71 patients admitted to the intensive care unit during from July 2012 to April 2016 were included in the current prospective study.The patients were assigned into the CRRT and non-CRRT groups based on whether the patients were accepted the CRRT.sCys C,uNGAL,uIL-18,serum creatine,blood urea nitrogen and leukocyte were measured on the day of admission.We collected blood and urinary samples at different time points (12h,24h)in order to measure sCys C,uNGAL,uIL-18 when the patients accepted difference post-replacement volume(2L/h and 4L/h) in CRRT.Multivariate logistic regression analysis was used to determine whether sCysC,uNGAL and uIL-18 levels were independent predictors of Sepsis complicated with AKI.A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve(AUC) was calculated to assess the predictive strength of sCys C,hNGAL and uIL-18.Results Compared to the Non-CRRT subjects,the age,the gender,Scr,BUN,WBC in the subjects of the CRRT group were of no significant diffience,but the levels of sCys C,uNGAL and uIL-18 were significantly higher(P ＜ 0.05).sCys C,uNGAL and uIL-18 achieved the AUC of 0.905(95％CI0.831-0.979,P=0.000),0.926(95％CI0.862-0.991,P=0.000),0.897(95％CI0.827 -0.967,P =0.000),respectively,for predicting the development of Sepsis complicated with AKI.No significant differences were noted between 2L/h group with 4L/h group at the beginning of CRRT.The levels of sCys C,uNGAL and uIL-18 decreased significantly in 2L/h and 4L/h groups at different time points (12h,24h) during CRRT.The levels of sCys C,uNGAL and uIL-18 in 4L/h group had decreased more significantly than 2L/h group at the 24h time point.Conclusion The authors consider that sCys C,uNGAL and uIL-18 are both independent predictors of Sepsis complicated with AKI in CRRT.uNGAL has a better predictive value in early prediction of Sepsis complicated with AKI in CRRT.There was more significant treatment effect in the post-replacement volume of 4L/h after 24h treatment in CRRT.