Clinical value of serum cell adhesion molecules in predicting of acute kidney injury in patients with severe sepsis / 中国医师进修杂志

ABSTRACT

Objective@#To assess the clinical value of serum cell adhesion molecules in predicting of acute kidney injury (AKI) in patients with severe sepsis.@*Methods@#The clinical data of 72 patients with severe sepsis from July 2015 to July 2017 in Sinopharm Dongfeng General Hospital were retrospectively analyzed. Among them, AKI occurred in 45 cases (AKI group), and AKI did not occur in 27 cases (non-AKI group). The clinical data of 2 groups were recorded; the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) on admission were evaluated; the blood routine, serum creatinine, C reactive protein, procalcitonin, lactic acid, intercellular adhesion molecular-1 (ICAM-1), E-selectin, P-selectin and vascular cell adhesion molecule-1 (VCAM-1) were detected.@*Results@#The incidences of infectious shock and respiratory failure, APACHE Ⅱ, SOFA, creatinine, lactic acid, ICAM-1, E-selectin, VCAM-1 in AKI group were significantly higher than those in non-AKI group 84.4% (38/45) vs. 51.9% (14/27), 51.1% (23/45) vs. 22.2% (6/27), (20.6 ± 2.8) scores vs. (15.9 ± 3.2) scores, (7.4 ± 1.5) scores vs. (4.5 ± 0.7) scores, (131.9 ± 48.7) μmol/L vs. (76.8 ± 10.3)μmol/L, (3.28 ± 0.78) mmol/L vs. (2.64 ± 0.37) mmol/L, (0.93 ± 0.12) mg/L vs. (0.59 ± 0.07) mg/L, (2.25 ± 0.20) mg/L vs. (1.13 ± 0.17) mg/L and (2.65 ± 0.31) mg/L vs. (1.86 ± 0.16) mg/L, and there were statistical differences (P < 0.01 or <0.05); there were no statistical differences in gender, age, basic disease, blood pressure, heart rate, respiratory frequency, infection site, white blood cell, lymphocyte ratio, platelet, blood glucose, C reactive protein, procalcitonin and P-selectin between 2 groups (P>0.05). Pearson correlation analysis result showed that serum ICAM-1, E-selectin, VCAM-1 were positively correlated with serum creatinine (r = 0.625, 0.358 and 0.441; P < 0.05); but there was no correlation between serum lactic acid and serum creatinine (r = 0.146, P > 0.05). Stepwise Logistic regression analysis result showed that creatinine, lactic acid, ICAM-1, E-selectin and VCAM-1 were independent risk factors of AKI in patients with severe sepsis (OR = 2.758, 1.710, 2.955, 1.801 and 2.218; 95% CI 1.845 to 4.371, 1.335 to 2.314, 1.674 to 4.163, 1.572 to 3.235 and 1.339 to 3.752; P < 0.01 or <0.05). The area under curve of serum ICAM-1, E-selectin, VCAM-1 combined detection for predicting of AKI in patients with severe sepsis was 0.876 (95% CI 0.777 to 0.942), with a specificity of 80.0% and a sensitivity of 85.2%.@*Conclusions@#serum ICAM-1, E-selectin, VCAM-1 combined detection can be used as predictor of AKI in patients with severe sepsis.