| 摘要: |
| 目的 探讨尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）联合急诊脓毒症死亡风险（MEDS）评分在脓毒症合并急性肾损伤（AKI）患者病情及预后的评估价值。方法 选取2013年1月至2015年12月入住上海中医药大学附属第七人民医院急诊科重症监护室且符合脓毒症合并AKI诊断标准的患者64例。依据2012年改善全球肾脏病预后组织（KDIGO）定义的AKI分期标准，将入选患者分为AKI 1期组（21例）、AKI 2期组（24例）和AKI 3期组（19例）；依据28 d内患者的存活情况，将患者分为死亡组（33例）和存活组（31例）。记录所有入选患者尿NGAL水平和MEDS评分，并比较不同AKI分期组以及存活组、死亡组的脓毒症患者尿NGAL水平和MEDS评分。绘制ROC曲线，分别评估尿NGAL、MEDS评分及两者联合对脓毒症合并AKI患者28 d病死率的预测能力，采用约登指数找出最佳临界值。结果 尿NGAL水平及MEDS评分随着脓毒症合并AKI分期的升高呈逐步上升趋势，3组之间差异有统计学意义（P<0.01）。死亡组的尿NGAL水平、MEDS评分高于存活组，差异有统计学意义（P<0.01）。ROC曲线分析显示尿NGAL及MEDS评分的曲线下面积（AUC）分别为0.885、0.841，最佳临界值分别为157.5 ng/mL、10.5。尿NGAL联合MEDS评分预测28 d病死率的AUC为0.936，敏感度91.4%，特异度89.2%，均优于单独使用尿NGAL或MEDS评分。结论 尿NGAL及MEDS评分均可作为脓毒症合并AKI病情严重性的预测指标，两者联合对预后具有更大的评估价值。 |
| 关键词: 尿 中性粒细胞明胶酶相关脂质运载蛋白 急诊脓毒症死亡风险评分 脓毒症 急性肾损伤 预后 |
| DOI：10.16781/j.0258-879x.2017.02.0244 |
| 投稿时间：2016-10-19修订日期：2017-01-21 |
| 基金项目: |
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| Urine neutrophil gelatinase-associated lipocalin and MEDS score in evaluating the severity and prognosis of sepsis patients with acute kidney injury |
| XI Xi-xiang1,2,LI Wen-fang1*,MA Jin-miao2,ZHANG Li-fen2,WANG Yi2 |
(1. Department of Emergency Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
2. Department of Emergency Medicine, Seventh People's Hospital of Shanghai, Shanghai University of TCM, Shanghai 200137, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the value of urine neutrophil gelatinase-associated lipocalin (NGAL) combined with mortality in emergency department sepsis (MEDS) score in evaluating the severity and prognosis of sepsis patients with acute kidney injury (AKI). Methods A total of 64 septic patients were selected from the intensive care unit of emergency department of Shanghai Seventh People's Hospital, and they were treated from January 2013 to December 2015. According to the AKI diagnostic criteria of Kidney Disease:Improving Global Outcomes (KDIGO), the patients were divided into group AKI1 (21 cases), group AKI2 (24 cases) and group AKI (19 cases). The patients were also divided into death group (33 cases) and survival group (31 cases) according to their survival state within 28 days. The urinary NGAL levels and MEDS score were compared between groups of different AKI stages and different survival states. ROC curves were plotted to assess the predictive abilities of urine NGAL, MEDS score and the combination of both for the 28 day mortality of sepsis patients with AKI, with Youden index used to identify the optimal cut-off value. Results The urinary NGAL level and MEDS score in the three groups of different stages gradually increased with the severity of the disease, showing significant difference (P<0.01). We also found that NGAL level and MEDS score in the death group were significantly higher than those in the survival group (P<0.01). ROC curve analysis showed that the areas under the curve (AUC) of urinary NGAL and MEDS score were 0.885 and 0.841, respectively, with the optimal cut-off values being 157.5 ng/mL and 10.5 points, respectively. The AUC of urinary NGAL combined with MEDS score for predicting 28 day fatality rate was 0.936, with the sensitivity being 91.4% and specificity being 89.2%, which were better than using urinary NGAL or MEDS score alone. Conclusion Both urine NGAL and MEDS score can be used as for predicting severity of sepsis patients with AKI, and the combination use of the two has even a greater value for the prognosis. |
| Key words: urine neutrophil gelatinase-associated lipocalin mortality in emergency department sepsis score sepsis acute kidney injury prognosis |
