重症脓毒症患者血清HBP和Presepsin水平对其急性肾损伤的预测

The Prediction of Serum HBP and Presepsin Levels on Acute Kidney Injury in Patients with Severe Sepsis

目的研究重症脓毒症患者血清肝素结合蛋白(heparin-binding protein,HBP)和可溶性白细胞分化抗原14亚型(sCD14-ST,Presepsin)水平对其急性肾损伤的预测效能。方法选择我院2022年9月至2023年9月诊断并进行治疗的120例重症脓毒症患者作为研究对象,依据《全球肾脏病预后组织急性肾损伤临床实践指南(2012)》相关标准,发生急性肾损伤(acute kidney injury,AKI)患者35例,非AKI患者85例。比较两组患者的血清HBP和Presepsin表达水平之间的差异,研究血清HBP和Presepsin联合检测对急性损伤的诊断效能。结果AKI组患者的HBP和Presepsin显著高于非AKI组(P<0.05);两组患者的心率、机械通气时间、ICU入住时间、收缩压、舒张压、平均动脉压、APACHEII、SOFA之间的差异无统计学意义(P>0.05),AKI组患者的中心静脉压、血肌酐、尿素氮、血乳酸显著高于非AKI组(P<0.05),较高的HBP、Presepsin、中心静脉压、血肌酐、尿素氮、血乳酸均是造成患者急性肾损伤的危险因素,血清HBP和Presepsin联合检测对急性肾损伤的预测灵敏度显著高于单独检测,通过ROC曲线分析,血清HBP和Presepsin联合检测对急性肾损伤的预测的曲线下面积显著高于单独检测,通过截断值分析,针对重症脓毒症患者而言,其合并急性肾损伤,其血清HBP和Presepsin分别为281.12ng/mL,1255.99pg/mL。结论重症脓毒症患者血清HBP和Presepsin表达水平对其急性肾损伤的预测具有显著的临床意义,可作为临床判定的重要依据。

Objective To evaluate predictive values of serum HBP and presepsin levels on acute kidney injury in patients with severe sepsis.Methods 120 patients diagnosed with severe sepsis and treated at our hospital from September,2022 to September,2023 were selected as the research subjects.According to the relevant criteria of the Global Renal Disease Prognostic Organization Acute Kidney Injury Clinical Practice Guidelines(2012),35 patients had AKI and 85 did not.The serum HBP and presepsin expression levels between the two groups were compared,and the diagnostic efficacy of combined detection of serum HBP and presepsin for acute injury was studied.Results HBP and presepsin levels in the AKI group were significantly higher than those in the non-AKI group(P<0.05).There was no significant difference between the two groups in terms of heart rate,mechanical ventilation time,ICU stay time,systolic pressure,diastolic pressure,mean arterial pressure,APACHE II,or SOFA scores(P>0.05).The central venous pressure,blood creatinine,blood urea nitrogen,and blood lactate levels were significantly higher in the AKI group than in the non-AKI group(P<0.05).Elevated HBP,presepsin,central venous pressure,blood creatinine,blood urea nitrogen,and blood lactate were all identified as risk factors for acute kidney injury.Combined detection of serum HBP and presepsin had a significantly higher sensitivity for predicting AKI than single-marker detection.ROC curve showed that the combined detection of serum HBP and presepsin had a significantly higher AUC value for predicting AKI than single-marker detection.According to the cutoff value analysis,the serum HBP and presepsin levels were 281.12 ng/mL and 1255.99 pg/mL,respectively,for severe sepsis patients with AKI.Conclusion The dynamic changes in serum HBP and presepsin expressions in patients with severe sepsis have significant clinical significances for predicting AKI and can serve as an important clinical standard.