收稿日期: 2024-07-09
网络出版日期: 2024-11-25
基金资助
国家自然科学基金项目(82100596)
The prognostic value of serum cystatin C combined with bedside renal ultrasound in patients with sepsis⁃induced acute kidney injury
Received date: 2024-07-09
Online published: 2024-11-25
目的 探讨血清胱抑素C（CysC）联合床旁肾脏超声对脓毒症急性肾损伤患者预后情况的评估价值。 方法 研究样本为安徽医科大学第一附属医院于2019年10月至2023年10月收治的134例脓毒症并发急性肾损伤患者，根据30 d内患者的预后情况，将其分为存活组（n = 93）和病死组（n = 41）。收集患者的临床资料，包括性别、年龄、心率、基础疾病、治疗情况、住院时间、基本生化指标、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）；检测患者肾功能指标［血肌酐（SCr）、尿素氮（BUN）］和CysC水平；通过床旁常规超声检测肾血流阻力指数（RI），并采用Cox回归分析评估脓毒症急性肾损伤患者预后不良的影响因素，并利用ROC曲线分析CysC联合床旁肾脏超声在脓毒症急性肾损伤患者预后评估中的应用价值。 结果 病死组患者的APACHEⅡ评分、SCr、BUN、CysC水平和RI分别为（25.14 ± 4.39）分、（115.93 ± 19.71）μmol/L、（13.65 ± 2.45）mmol/L、（3.10 ± 0.51）mg/L和（0.71 ± 0.16），均高于存活组，差异均有统计学意义（P < 0.05）。Cox回归分析显示，CysC水平和RI均是影响患者预后的重要因素（P < 0.05）；ROC曲线显示，CysC水平和RI的联合检测对脓毒症急性肾损伤患者的预后情况有较高的诊断效能，准确度为97.5%。 结论 CysC水平和床旁肾脏超声可作为脓毒症急性肾损伤患者的预后评估指标，指导临床治疗。
戴成才 , 程振兴 , 涂倩倩 . 血清胱抑素C联合床旁肾脏超声对脓毒症急性肾损伤患者预后情况的评估价值[J]. 实用医学杂志, 2024 , 40(22) : 3226 -3231 . DOI: 10.3969/j.issn.1006-5725.2024.22.018
Objective To assess the prognostic significance of serum cystatin C （CysC） in combination with bedside renal ultrasound for patients diagnosed with sepsis-induced acute kidney injury （AKI）. Methods The study cohort comprised 134 patients with sepsis-induced AKI who were admitted to our hospital between October 2019 and October 2023. Based on the 30 day prognosis， the patients were categorized into a survival group （n = 93） and a death group （n = 41）. Collected clinical data included gender， age， heart rate， underlying diseases， treatment modalities， duration of hospital stay， basic biochemical indicators， and Acute Physiology and Chronic Health Evaluation Ⅱ（APACHEⅡ） scores. Renal function markers such as serum creatinine （SCr）， blood urea nitrogen （BUN）， and cystatin C levels were measured； renal blood flow resistance index （RI） was assessed using bedside routine ultrasound. Cox regression analysis was employed to evaluate factors influencing poor prognosis in patients with sepsis-induced AKI while analyzing the prognostic assessment value of combining cystatin C with bedside renal ultrasound through ROC curves. Results The death group exhibited significantly higher APACHEⅡ scores， SCr， BUN， CysC levels， and RI （all P < 0.05） compared to the survival group. Cox regression analysis revealed that both CysC levels and RI were significant prognostic indicators （P < 0.05）. ROC curve analysis demonstrated that the combined assessment of CysC levels and RI yielded a high diagnostic accuracy of 97.5% in predicting outcomes for patients with sepsis-induced AKI. Conclusion CysC levels and bedside renal ultrasound can serve as prognostic indicators for patients with sepsis-induced acute kidney injury （AKI）， thereby guiding clinical treatment.
Key words： serum cystatin C; bedside ultrasound; sepsis; acute kidney injury; poor prognosis
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