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

doi:10.3969/j.issn.1006-5725.2024.22.018

Abstract

Abstract:

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

CLC Number:

Chengcai DAI,Zhenxing CHENG,Qianqian TU. The prognostic value of serum cystatin C combined with bedside renal ultrasound in patients with sepsis⁃induced acute kidney injury[J]. The Journal of Practical Medicine, 2024, 40(22): 3226-3231.

Figures/Tables 5

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References 22

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项目	病死组（n = 41）	存活组（n = 93）	t/χ ² 值	P值
年龄（x ± s）/岁	55.90 ± 6.15	56.14 ± 6.29	0.205	0.838
性别/［例（%）］			0.174	0.677
男	20（48.78）	49（52.69）
女	21（51.22）	44（47.31）
BMI（x ± s）/（kg/m²）	22.29 ± 3.35	22.75 ± 3.58	0.763	0.447
高血压史/［例（%）］	13（24.39）	19（22.58）	1.991	0.158
糖尿病史/［例（%）］	11（26.83）	18（19.35）	0.937	0.333
冠心病史/［例（%）］	9（21.95）	13（13.98）	1.318	0.251
吸烟史/［例（%）］	19（46.34）	31（33.33）	2.059	0.151
饮酒史/［例（%）］	22（53.66）	35（37.63）	2.989	0.084
白细胞计数（x ± s）/（10⁹/L）	13.27 ± 2.58	12.91 ± 2.40	0.836	0.405
血红蛋白（x ± s）/（g/L）	101.24 ± 23.69	101.11 ± 20.82	0.034	0.973
白蛋白（x ± s）/（g/L）	30.01 ± 3.22	30.56 ± 4.40	0.811	0.419
血小板压积（x ± s）/%	0.24 ± 0.07	0.23 ± 0.08	0.762	0.447
红细胞压积（x ± s）/%	35.42 ± 4.61	35.79 ± 4.89	0.448	0.655
TC（x ± s）/（mmol/L）	5.04 ± 0.75	5.06± 0.84	0.131	0.896
TG（x ± s）/（mmol/L）	1.74 ± 0.74	1.72 ± 0.69	0.151	0.880
LDL-C（x ± s）/（mmol/L）	3.05 ± 0.69	2.99 ± 0.51	0.579	0.564
HDL-C（x ± s）/（mmol/L）	1.18 ± 0.35	1.19 ± 0.38	0.157	0.875

影响因素	病死组（n = 41）	存活组（n = 93）	t/χ ² 值	P值
使用机械通气/［例（%）］	36（59.02）	31（42.47）	3.064	0.080
使用血管活性药物/［例（%）］	33（54.10）	29（39.73）	2.761	0.097
ICU住院时间（x ± s）/d	12.82 ± 2.96	12.75 ± 2.67	0.144	0.886
APACHE Ⅱ评分（x ± s）/分	25.14 ± 4.39	20.35 ± 4.03	6.578	< 0.001
SCr（x ± s）/（μmol/L）	115.93 ± 19.71	102.47 ± 13.43	4.679	< 0.001
BUN［M（P₂₅，P₇₅）］/（mmol/L）	13.65（11.87，14.99）	7.55（6.71，8.34）	9.836	< 0.001
CysC［M（P₂₅，P₇₅）］/（mg/L）	3.11（2.76，3.46）	2.36（2.18，2.56）	7.491	< 0.001
RI（x ± s）	0.71 ± 0.16	0.60 ± 0.13	4.198	< 0.001

项目	单因素分析		多因素分析
项目	CysC	RI	CysC	RI
B	1.849	0.108	0.828	0.057
SE	0.247	0.023	0.298	0.024
Wald χ²	56.061	21.904	7.720	5.708
P值	< 0.001	< 0.001	0.005	0.017
OR	6.354	1.114	2.290	1.059
95%CI	3.916 ~ 10.310	1.065 ~ 1.165	1.276 ~ 4.108	1.010 ~ 1.109

指标	灵敏度/%	特异度/%	约登指数	截断值	AUC	95%CI
CysC	83.6	87.7	0.713	2.70	0.876	0.813 ~ 0.940
RI	73.8	68.5	0.423	41.10	0.743	0.658 ~ 0.829
联合	95.1	91.8	0.869	-	0.975	0.954 ~ 0.996

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The prognostic value of serum cystatin C combined with bedside renal ultrasound in patients with sepsis⁃induced acute kidney injury

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