Abstract
Background: Acute kidney injury (AKI) is one of the most severe complications of sepsis. This study was conducted to analyze the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary kidney injury molecular-1 (uKIM-1), and urinary angiotensinogen (uAGT) in the early diagnosis and mortality prediction of septic AKI.
Methods: The prospective study enrolled 80 sepsis patients in the ICU and 100 healthy individuals and divided patients into an AKI group and a non-AKI group. uNGAL, uKIM-1, uAGT, serum creatinine/procalcitonin/C-reaction protein, and other indicators were determined, and clinical prediction scores were recorded. The sensitivity and specificity of uNGAL, uKIM-1, and uAGT in diagnosis and mortality prediction were analyzed by the receiver operator characteristic (ROC) curve and the area under the curve (AUC).
Results: uNGAL, uKIM-1, and uAGT levels were higher in sepsis patients than healthy controls, higher in AKI patients than non-AKI patients, and higher in AKI-2 and AKI-3 patients than AKI-1 patients. At 0 h after admission, the combined efficacy of three indicators in septic AKI diagnosis (ROC-AUC: 0.770; sensitivity: 82.5%; specificity: 70.0%) was better than a single indicator. At 24 h, uNGAL, uKIM-1, and uAGT levels were higher in sepsis non-survivals than survivals and higher in septic AKI non-survivals than septic AKI survivals. The combined efficacy of three indicators in the prediction of sepsis/septic AKI mortality (ROC-AUC: 0.828/0.847; sensitivity: 71.4%/100.0%; specificity: 82.7%/66.7%) was better than a single indicator.
Conclusion: uNGAL, uKIM-1, and uAGT levels were increased in septic AKI, and their combination helped the early diagnosis and mortality prediction.
Keywords: Sepsis, acute kidney injury, uNGAL, uKIM-1, uAGT, early diagnosis, severity assessment, mortality.
[http://dx.doi.org/10.1503/cmaj.170149] [PMID: 30201611]
[http://dx.doi.org/10.1111/micc.12483] [PMID: 29908046]
[http://dx.doi.org/10.2215/CJN.03681106] [PMID: 17699448]
[http://dx.doi.org/10.1111/vec.12297] [PMID: 25845505]
[http://dx.doi.org/10.1159/000339789] [PMID: 22890468]
[http://dx.doi.org/10.1186/cc2872] [PMID: 15312219]
[http://dx.doi.org/10.1038/nrneph.2009.225] [PMID: 20111048]
[http://dx.doi.org/10.1016/j.jcrc.2015.09.017] [PMID: 26475099]
[http://dx.doi.org/10.1016/j.cca.2022.08.029] [PMID: 36150522]
[http://dx.doi.org/10.1097/01.ASN.0000088027.54400.C6] [PMID: 14514731]
[http://dx.doi.org/10.1172/JCI75417] [PMID: 25751064]
[http://dx.doi.org/10.17691/stm2021.13.3.08] [PMID: 34603757]
[http://dx.doi.org/10.3109/0886022X.2014.949764] [PMID: 25154466]
[http://dx.doi.org/10.3389/fped.2022.1024713] [PMID: 36545669]
[http://dx.doi.org/10.1038/ncpneph1015] [PMID: 19065132]
[http://dx.doi.org/10.1093/ckj/sfx087] [PMID: 29225804]
[http://dx.doi.org/10.1186/cc12612] [PMID: 23587112]
[http://dx.doi.org/10.2215/CJN.06280612] [PMID: 23143504]
[http://dx.doi.org/10.1001/jama.2016.0287] [PMID: 26903338]
[http://dx.doi.org/10.1007/s00134-017-4683-6] [PMID: 28101605]
[http://dx.doi.org/10.1038/kisup.2011.32] [PMID: 25018918]
[http://dx.doi.org/10.1016/j.cca.2021.08.029] [PMID: 34480953]
[http://dx.doi.org/10.1186/s40001-022-00654-7] [PMID: 35272698]
[http://dx.doi.org/10.1053/j.ajkd.2008.01.020] [PMID: 18725016]
[http://dx.doi.org/10.1186/s12882-018-0977-3] [PMID: 29980183]
[http://dx.doi.org/10.2217/bmm.13.5] [PMID: 23734805]
[http://dx.doi.org/10.1186/s13054-016-1212-x] [PMID: 26880194]
[PMID: 35751900]
[http://dx.doi.org/10.1186/s13017-018-0202-5] [PMID: 30214469]
[http://dx.doi.org/10.1016/j.jcrc.2015.08.019] [PMID: 26421697]
[http://dx.doi.org/10.1159/000364937] [PMID: 25170751]
[PMID: 32495895]
[http://dx.doi.org/10.1186/1471-2369-14-273] [PMID: 24321290]
[http://dx.doi.org/10.3390/biomedicines10051106] [PMID: 35625842]
[http://dx.doi.org/10.12659/MSM.916400] [PMID: 31401645]
[PMID: 22918624]
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.122.18731] [PMID: 35904033]
[http://dx.doi.org/10.1002/jcla.24358] [PMID: 35334494]
![Wayfinder Image](/images/wayfinder.jpg)