血清NGAL联合乳酸及APACHEⅡ评分对脓毒性休克合并急性肾损伤患者病死的预测价值

Prognostic value of serum NGAL combined with lactic acid and APACHEⅡscore in patients with septic shock complicated with acute kidney injury

目的:探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合急性生理和慢性健康评分(APACHEⅡ)、血乳酸对脓毒性休克所致急性肾损伤(AKI)患者病死的预测价值。方法:选择2017年9月—2020年8月我院收治的50例脓毒性休克合并AKI患者,根据患者预后分为死亡组23例、存活组27例。比较两组患者一般临床资料、血清NGAL、血肌酐、APACHEⅡ评分、血乳酸及降钙素原(PCT)等,并比较血清NGAL、APACHEⅡ评分、血乳酸单独检测与三者联合检测在预测脓毒性休克所致AKI患者病死的差别。结果:死亡组血清NGAL、血乳酸、APACHEⅡ评分检测值均明显高于存活组(Z=-3.280、Z=-2.931、t=5.013,均P<0.01)。受试者工作特征曲线(ROC曲线)分析显示,血清NGAL、APACHEⅡ、血乳酸及三者联合检测预测脓毒性休克合并AKI患者病死的曲线下面积分别为:0.793(95%CI:0.668~0.918,P<0.01)、0.813(95%CI:0.696~0.931,P<0.01)、0.675(95%CI:0.516~0.833,P<0.01)、0.885(95%CI:0.797~0.975,P<0.01),敏感性分别为87.5%、87.5%、58.3%、75%,特异性分别为65.4%、61.5%、84.6%、92.3%,约登指数分别为0.529、0.490、0.429、0.673,三者联合检测高于单独检测。结论:血清NGAL、APACHEⅡ评分、血乳酸三者联合检测对脓毒性休克所致AKI患者病死的预测有较高的临床应用价值。

Objective:To investigate the predictive value of serum neutrophil gelatinase-associated apolipoprotein(NGAL)combined with acute physiology and chronic health evaluation(APACHEⅡ)score and blood lactic acid in patients with acute kidney injury(AKI)induced by septic shock.Methods:From January 2017 to August 2020,50 patients with septic shock complicated with AKI were selected.According to the prognosis of the patients,they were divided into death group(n=23)and survival group(n=27).The general clinical data,serum NGAL,serum creatinine,APACHEⅡ score,blood lactic acid and PCT were analyzed,and the differences of serum NGAL,APACHEⅡ score,blood lactic acid and their combined detection in predicting the death of patients with AKI by septic shock were compared.Results:The serum NGAL,latic acid and APACHEⅡ score in the death group were significantly higher than those in the survival group(Z=-3.280,Z=-2.931,t=5.013,all P<0.01).Receiver operating characteristic curve(ROC curve)of the subjects showed that the areas under the curve of serum NGAL,APACHEⅡ,blood lactic acid and their combined detection in predicting the death of patients with AKI by septic shock were 0.793(95%CI:0.668-0.918,P<0.01),0.813(95%CI:0.696-0.931,P<0.01),0.675(95%CI:0.516-0.833,P<0.01)and 0.885(95%CI:0.797-0.975,P<0.01),sensitivity was 87.5%,87.5%,58.3%,75%,specificity was 65.4%,61.5%,84.6%,92.3%,and the Jordan advised was 0.529,0.490,0.429 and 0.673.The combination detection of the three methods was higher than those of the single test.Conclusion:The combined detection of serum NGAL,APACHEⅡ score and blood lactic acid has high clinical application value in predicting death of patients with AKI by septic shock.