超声造影在脓毒症相关急性肾损伤诊断及预后预测中的临床价值

Clinical value of contrast-enhanced ultrasound in the diagnosis and prognosis prediction of sepsis-associated acute kidney injury

目的应用超声造影诊断脓毒症相关急性肾损伤(AKI)并预测其预后,探讨其临床价值。方法前瞻性连续纳入2021年8月至2022年4月我院重症医学科收治的脓毒症患者51例,分别于入院24 h内(D1)及第3天(D3)行超声造影,获取峰值强度(PI)、达峰时间(TTP)、曲线下面积(AUC)。以是否发生AKI将患者分为AKI组27例和非AKI组24例,进一步以是否为持续性AKI将AKI组患者分为AKI持续组8例和AKI恢复组19例,以是否死亡将AKI组患者分为存活组22例和死亡组5例,比较各组间超声造影定量参数的差异。应用单因素Logistic回归分析脓毒症相关AKI的影响因素;绘制受试者工作特征(ROC)曲线分析超声造影定量参数预测脓毒症相关AKI的诊断效能。结果AKI组与非AKI组AUC、PI比较差异均有统计学意义(均P<0.05)。与AKI持续组比较,AKI恢复组D3时AUC、PI均增加,TTP减少,差异均有统计学意义(均P<0.05);AKI恢复组D3时AUC、PI均较D1时增加,TTP较D1时减少,差异均有统计学意义(均P<0.05)。存活组与死亡组不同时间超声造影定量参数比较差异均无统计学意义。单因素Logistic回归分析显示AUC、PI、TTP均为预测脓毒症相关AKI的影响因素(OR=0.88、0.89、1.08,均P<0.05)。ROC曲线分析显示,AUC、PI、TTP预测脓毒症相关AKI的曲线下面积分别为0.74、0.70、0.70(均P<0.05)。结论超声造影可准确诊断脓毒症相关AKI并预测其预后,具有较好的临床应用价值。

Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS)in the diagnosis and prognosis of sepsis-associated acute kidney injury(AKI).Methods Fifty-one patients with sepsis admitted to the intensive care unit of our hospital from August 2021 to April 2022 were enrolled.CEUS was performed within 24 h of admission(D1)and on the third day(D3)to obtain peak intensity(PI),time to peak(TTP),and area under the curve(AUC).The patients were divided into AKI group(n=27)and non-AKI group(n=24)according to the presence or absence of AKI.The patients in AKI group were further divided into AKI persistence group(n=8)and AKI recovery group(n=19)according to the presence or absence of AKI,as well as survival group(n=22)and death group(n=5)according to presence or absence of death.Univariate Logistic regression was used to analyze the influencing factors of sepsis-associated AKI,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of CEUS in predicting sepsis-associated AKI.Results There were significant differences in AUC,PI and TTP between AKI group and non-AKI group(all P<0.05).Compared with AKI persistence group,AUC and PI increased and TTP decreased at D3,and the differences were statistically significant(all P<0.05).In the AKI recovery group,AUC and PI at D3 were significantly higher than those at D1,and TTP was significantly lower than those at D1(all P<0.05).There were no significant difference in the quantitative parameters of contrast-enhanced ultrasound between the survival group and the death group at different time points.Univariate Logistic regression analysis showed that AUC,PI and TTP were the influencing factors of sepsis-associated AKI(OR=0.88,0.89,1.08,all P<0.05).ROC curve analysis showed that the area under the curve of AUC,PI and TTP for predicting sepsis-associated AKI were 0.74,0.70 and 0.70,respectively(all P<0.05).Conclusion CEUS can accurately diagnose sepsis-associated AKI and predict its prognosis,which has good clinical application value.