Urine neutrophil gelatinase-associated lipocalin and MEDS score in evaluating the severity and prognosis of sepsis patients with acute kidney injury / 第二军医大学学报

ABSTRACT

Objective To evaluate the value of urine neutrophil gelatinase-associated lipocalin (NGAL) combined with mortality in emergency department sepsis (MEDS) score in evaluating the severity and prognosis of sepsis patients with acute kidney injury (AKD. Methods A total of 64 septic patients were selected from the intensive care unit of emergency department of Shanghai Seventh People’s Hospital, and they were treated from January 2013 to December 2015. According to the AKI diagnostic criteria of Kidney Disease; Improving Global Outcomes (KDIGO), the patients were divided into group AKI1 (21 cases), group AKI2 (24 cases) and group AKI (19 cases). The patients were also divided into death group (33 cases) and survival group (31 cases) according to their survival slate within 28 days. The urinary NGAL levels and MEDS score were compared between groups of different AKI stages and different survival slates. ROC curves were plotted to assess the predictive abilities of urine NGAL, MEDS score and the combination of both for the 28 day mortality of sepsis patients with AKI, with Youden index used to identify the optimal cut-off value. Results The urinary NGAL level and MEDS score in the three groups of different stages gradually increased with the severity of the disease, showing significant difference (P<0. 01). We also found that NGAL level and MEDS score in the death group were significantly higher than those in the survival group (P<0. 01). ROC curve analysis showed that the areas under the curve (AUC) of urinary NGAL and MEDS score were 0. 885 and 0. 841, respectively, with the optimal cut-off values being 157. 5 ng/mL and 10. 5 points, respectively. The AUC of urinary NGAL combined with MEDS score for predicting 28 day fatality rate was 0. 936, with the sensitivity being 91. 4% and specificity being 89. 2%, which were better than using urinary NGAL or MEDS score alone. Conclusion Both urine NGAL and MEDS score can be used as for predicting severity of sepsis patients with AKI. and the combination use of the two has even a greater value for the prognosis.