脓毒症相关急性肾损伤的早期监测指标

Early monitoring index for sepsis-related acute kidney injury

目的探讨脓毒症相关急性肾损伤早期监测指标的预测价值。方法 2012年1月～2014年1月本院重症医学科收治脓毒症患者307例,共245例患者纳入研究,将其根据急性肾损伤诊断标准分为急性肾损伤组和非急性肾损伤组,采用受试者工作特征曲线评价脓毒症相关急性肾损伤早期监测指标的预测价值。结果 54例患者发生急性肾损伤。急性肾损伤组入科后6 h液体正平衡量多于非急性肾损伤组[(723.3±50.2)ml vs(414.5±23.7)ml],差异有统计学意义(P=0.024);急性肾损伤组入科后6 h血清胱抑素C高于非急性肾损伤组[(1.2±0.1)mg/L vs(0.9±0.1)mg/L],差异有统计学意义(P=0.015)。两组的尿量、尿素氮、尿β2-微球蛋白、尿微量白蛋白比较差异无统计学意义(P>0.05)。入科后6 h液体正平衡量、血清胱抑素C的AUC-ROC分别为0.892、0.873。入科后6 h液体正平衡量对急性肾损伤的预测价值优于血清胱抑素C。当入科后6 h液体正平衡量为612 ml时,灵敏度和特异度分别为85.8%、91.2%。结论入科后6 h液体正平衡量是预测脓毒症相关急性肾损伤的良好指标。

Objective To explore the prediction value of early monitoring index for sepsis-related acute kidney injury.Methods From January 2012 to January 2014,307 patients with sepsis were received and treated by department of critical care medicine in our hospital,245 patients were included the study,and patients were divided into acute kidney injury group and no acute kidney injury group according to the diagnostic standard of acute kidney injury.Receiver operating characteristic(ROC) curve was used to evaluate the prediction value of early monitoring index for sepsis-related acute kidney injury. Results 54 subjects developed acute kidney injury.Positive fluid balance in acute kidney injury group was significantly more than that in no acute kidney injury group [(723.3±50.2) ml vs(414.5±23.7) ml],and there was a statistical difference(P=0.024).Cystatin C after 6 hours in acute kidney injury group was significantly higher than that in no acute kidney injury group [(1.2±0.1) mg/L vs(0.9± 0.1) mg/L,and there was a statistical difference(P=0.015).There was no statistical difference of urine volume,blood urea nitrogen,urinary β2-microglobulin and urine Micro-albumin between two groups(P>0.05).AUC-ROC of positive fluid balance and Cystatin C after 6 hours was 0.892 and 0.873 respectively.Prediction value of positive fluid balance after 6 hours was better than Cystatin C.When positive fluid balance after 6 hours was 612 ml,the sensitivity and specificity was 85.8% and 91.2% respectively. Conclusion Positive fluid balance is a good index to predict sepsis-related acute kidney injury.