血清PenKid是脓毒症相关急性肾损伤发生与死亡的危险因素

PenKid is a risk factor for sepsis-associated acute kidney injury and death

目的本研究旨在研究血清脑啡肽原119-159(Proenkephalin A 119-159,penKid)对脓毒症相关急性肾损伤(Sepsis-associated Acute Kidney Injury,SA-AKI)发生及死亡的预测价值。方法本研究是一项单中心、观察性队列研究。选取2021年9月至2022年9月泰州市人民医院重症医学科新收治的脓毒症/脓毒性休克患者,根据28 d内是否发生急性肾损伤(acute kidney injury,AKI)分为SA-AKI组和非SA-AKI组,在SA-AKI组中根据28 d内是否发生死亡分为死亡组和存活组,分别比较不同分组基线资料及penKid浓度等实验室指标。使用COX回归分析探讨SA-AKI组患者28 d内死亡的危险因素,使用Kaplan-Meier曲线分析患者预后。结果本研究共纳入161例患者,其中66例(41.0%)发生AKI。SA-AKI组基线penKid浓度显著高于非SA-AKI组[(2.99±0.68)μg/L vs(1.86±0.75)μg/L,P<0.05],多因素COX回归分析显示,基线penKid(HR=5.608,95%CI:3.507~8.967,P<0.001)和血乳酸(Lactate,LA)(HR=1.089,95%CI:1.003~1.183,P=0.043)是脓毒症/脓毒性休克患者发生AKI的独立危险因素。在66例SA~AKI患者中,有27例(40.9%)在28 d内死亡,死亡组患者基线penKid浓度显著高于存活组[(3.55±0.54)μg/L vs(2.60±0.47)μg/L,P<0.05];COX回归分析结果显示,penKid(HR=5.892,95%CI:2.457~14.132,P<0.001)是SA-AKI患者发生死亡的独立危险因素;Kaplan-Meier曲线显示基线penKid<3.24μg/L的患者28 d总存活率显著高于基线penKid≥3.24μg/L的患者(P<0.001)。结论在脓毒症/脓毒性休克患者中,SA-AKI组第1天测得的penKid浓度显著高于非SA-AKI组;在SA-AKI患者中,28 d内存活的患者测得的penKid浓度显著低于死亡组,penKid是SA-AKI发生与死亡的独立危险因素。

Objective To investigate the predictive value of serum proenkephalin A 119-159(penKid)on incidence and the 28-day mortality in patients with sepsis-associated acute kidney injury(SA-AKI).Methods This study was a single center,observational cohort study.Sepsis/septic shock patients admitted to Department of Critical Care Medicine of Taizhou People's Hospital Affiliated to Nanjing Medical University from September 2021 to September 2022 were selected and divided into the SA-AKI group and the non-SA-AKI group according to whether acute kidney injury(AKI)occurred within 28 days.Patients in the SA-AKI group were subdivided into the death group and the survival group according to whether death occurred within 28 days.Baseline data and laboratory indicators such as penKid concentration were compared among different groups.COX regression analysis was used to explore the risk factors of death within 28 days in the SA-AKI patients,And Kaplan-Meier curve was used to analyze patient prognosis.Result A total of 161 patients were included in this study,of whom 66(41.0%)developed AKI.The baseline penKid concentration in the SA-AKI group was signifi cantly higher than that in the non-SA-AKI group[(2.99±0.68)μg/L vs.(1.86±0.75)μg/L,P<0.05].Multivariate COX regression analysis showed that the baseline penKid(HR=5.608,95%CI:3.507-8.967,P<0.001)and lactate(LA)(HR=1.089,95%CI:1.003-1.183,P=0.043)were independent risk factors for AKI in sepsis/septic shock patients.Of the 66 SA-AKI patients,27(40.9%)died within 28 days,and the baseline penKid concentration in the death group was signifi cantly higher than that in the survival group[(3.55±0.54)μg/L vs.(2.60±0.47)μg/L,P<0.05].COX regression analysis showed that penKid(HR=5.892,95%CI:2.457-14.132,P<0.001)was an independent risk factor for mortality in SA-AKI patients.Kaplan-Meier curve showed that the 28-day mortality of patients with baseline penKid≥3.24μg/L was signifi cantly higher than that of patients with baseline penKid<3.24μg/L(P<0.001).Conclusions In sepsis/septic shock patients,the penKid concentration measured on the fi rst day in the SA-AKI group is signifi cantly higher than that in the non-SA-AKI group.In SA-AKI patients,the penKid concentration measured in patients who survived within 28 days is significantly lower than that in the death group.PenKid is an independent risk factor for the occurrence and death of SA-AKI.