血清尿酸是脓毒症相关急性肾损伤的独立危险因素

Serum uric acid is an independent risk factor for acute kidney injury in patients with sepsis

目的:探讨入院血清尿酸(SUA)对脓毒症相关急性肾损伤(SA-AKI)的临床预测价值。方法:采用回顾性队列研究,分析武汉大学中南医院重症监护病房(ICU)收治的420例确诊为脓毒症患者的临床资料,根据急性肾损伤(AKI)和高尿酸血症诊断标准将患者分为AKI组和非急性肾损伤(NAKI)组以及高尿酸组和非高尿酸组,比较2组间临床资料及相关结局指标的差异。结果:本研究中高尿酸血症共175例(41.7%);AKI的发病率为64%(269/420),其中高尿酸组为94.3%(165/175),非高尿酸组为42.4%(104/245),AKI组SUA水平高于NAKI组,以上差异均具有统计学意义(χ2=119.124,Z=14.596,均为P<0.001)。在校正了人口统计学和临床变量等指标后,多因素Logistic回归分析显示:SUA是SA-AKI的独立危险因素[SUA(OR=1.023,95%CI:1.015~1.030,P<0.001)、高尿酸血症(OR=9.578,95%CI:3.327~27.574,P<0.001)]。SUA预测SA-AKI的ROC曲线下面积(AUC)为0.929(95%CI:0.905~0.952,P<0.001),以294.8μmol/L作为诊断界值,敏感度为90.7%,特异度为76.2%,且高于Scr对SA-AKI的预测(0.929 vs 0.713,Z=7.543,P<0.001)。结论:入院SUA是SA-AKI强有力的独立预测因子,SUA可能参与了AKI的发生发展,对其适当干预可能有利于预防AKI的发生,在临床实践中应当给予关注。

Objective:To explore the clinical predictive value of admission serum uric acid(SUA) for sepsisassociated acute kidney injury(SA-AKI).Methods:This was a retrospective analysis of 420 patients diagnosed as sepsis admitted to Intensive Care Unit(ICU) of Zhongnan Hospital of Wuhan University.According to the AKI and hyperuricemia diagnostic criteria, patients were divided into two groups and the differences of clinical information and related outcome indicators were.Results:The incidence of hyperuricemia was 41.7%, and the overall incidence of AKI was 64%, of which 94.3% in hyperuric acid group and 42.4% in non-hyperuric acid group, the level of SUA in the AKI group was higher than that in the NAKI group, and the above differences were statistically significant(χ2=119.124,Z=14.596, P<0.001).After adjusting the demographic and clinical variables, multivariate logistic regression analysis showed that SUA is an independent risk factor for SA-AKI [SUA(OR=1.023,95%CI:1.015-1.030, P<0.001), hyperuricemia(OR=9.578, 95%CI:3.327-27.574, P<0.001)].The area under the ROC curve(AUC) of SUA for SA-AKI was 0.929(95%CI:0.905-0.952, P<0.001), using 294.8 μmol/L as the diagnostic cut-off value, the sensitivity was 90.7%,and the specificity was 76.2%, which was higher than Scr’s prediction for SA-AKI(0.929 vs 0.713,Z=7.543, P<0.001).Conclusion:The admission SUA is a powerful independent predictor for SAAKI, SUA may be involved in the pathogenesis of AKI, and appropriate intervention may be beneficial to reduce the occurrence of AKI, and should be paid attention in the clinical practice.