Early diagnostic value of urinary insulin-like growth factor binding protein-7 in patients with sepsis-induced acute kidney injury / 中华急诊医学杂志

ABSTRACT

Objective To evaluate the early diagnostic value of urinary insulin-like growth factor binding protein-7 (IGFBP-7) in sepsis-induced acute kidney injury (AKI),and to compare the effects of urinary IGFBP-7 to that of serum cystatin-C (sCys-C) and serum creatinine (sCr) on predicting the severity of sepsis-induced AKI patients.Methods A total of 105 patients with sepsis admitted to ICU in Tianjin First Hospital from September 2015 to August 2016 were divided into AKI group (n =48) and non-AKI group (n =57) according to the AKI diagnostic criteria.The samples of blood and urine of the patients were collected at 0,3,6,12,24 and 48 h,to measure the levels of urinary IGFBP-7,and serum Cys-C and sCr.Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC),the early diagnostic value of urinary IGFBP-7,and serum sCys-C and sCr in sepsis-induced AKI patients was determined.Results With the increase in length of ICU stay,the levels of urinary IGFBP-7,and serum sCys-C and sCr in AKI patients increased gradually.There was a significant difference between the two groups in the level of IGFBP-7 at 3 h [2.34 (2.03,4.19) ng/mL vs.1.79 (1.51,2.62) ng/mL,P ＜0.05].At 6 h,the difference in sCys-C between two groups was statistically significant [(1.63 ± 0.42)ng/mL vs.(1.20 ±0.46) ng/mL,P ＜ 0.05].At 12 h,the difference in sCr between two groups was statistically significant [80.5 (74.3,88.0) ng/mL vs.77.0 (67.0,84.0) ng/mL,P ＜ 0.05].The AUCs of urinary IGFBP-7 and sCys-C of sepsis-induced AKI patients were 0.881 (95％ CI0.813-0.949) and 0.782 (95％ CI0.692-0.872),which were superior to those in AUC of sCr 0.629 (95％CI0.522-0.737).When the cutoff value of urinary IGFBP-7 was 1.82 ng/mL,the sensitivity was 93.8％ and the specificity was 77.2％.Conclusions Urine IGFBP-7 and sCys-C have higher predictive value in sepsis-induced AKI than sCr,whereas urine IGFBP-7 is more sensitive and specific than sCys-C,suggesting that IGFBP-7 may be used as sepsis signs of early diagnosis of AKI.