KDIGO分期标准联合NGAL对严重脓毒症患者伴发急性肾损伤血液净化治疗预后的判断

Prognosis evaluation of acute kidney injury with KDIGO staging criteria and NGAL in severe sepsis patients treated with continuous blood purification

目的 探讨急性肾损伤（acute kidney injury,AKI）改善全球肾病预后组织（kidneydisease：improving global outcomes organization,KDIGO）分期标准联合中性粒细胞明胶酶相关脂质转运蛋白（neutrophil gelatinase-associated lipocalin,NGAL）对严重脓毒症患者伴AKI选择连续性血液净化治疗（continuous blood purification,CBP）后的预后判断价值.方法 采用前瞻性研究方法,选择84例北京顺义区医院EICU 2013年1月至2014年12月收治的严重脓毒症伴AKI需进行静-静脉CBP治疗的患者,采用KDIGO分期标准将入选患者分为KDIGO1、2、3期组,对各组患者血液NGAL水平,EICU的住院存活率以及存活患者肾功能转归进行比较.结果 KDIGO1、2期患者的NGAL血液水平（453.9±74.4） ng/mL明显低于KDIGO3期患者（789.1±86.8）ng/mL,P＜ 0.01;KDIGO1、2期患者28 d存活率显著高于KDIGO3期患者[92.3％ （24/26）：69.0％（40/58）,P=0.026];KDIGO1、2期中存活患者肾功能改善率显著高于KDIGO3期患者[83.3％（20/24）：27.5％ （11/40）,P＜0.01];KDIGO分期联合血液NGAL分别预测严重脓毒症伴AKI行CBP治疗患者住院存活以及肾功能改善预后的受试者工作特征（receiver operator characteristic,ROC）曲线,分析其曲线下面积分别为0.703（95％ CI：0.648～0.759,P＜0.001）和0.679（95％ CI：0.627 ～0.731,P＜0.01）.结论 严重脓毒症患者伴发AKI,在KDIGO1、2期时给予CBP治疗,可以提高患者住院生存率并且改善生存患者肾功能;KDIGO分期联合血液NGAL对严重脓毒症患者伴发AKI行CBP治疗的患者可进行有效的预后评估.

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.