Abstract:

Objective To explore the prognostic value of coagulation function index combined with serum cystatin C（CysC）in patients with acute kidney injury（AKI）caused by sepsis. Methods A prospective study was performed. Seventy ⁃eight patients with septic AKI hospitalized in the ICU of Ningxia Medical University General Hospital from October 2018 to June 2020 were selected and divided into death group and survival group according to the 28⁃day outcome. Clinical data such as sex，age，past medical history，acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score and laboratory indexes such as platelet count（PLT），prothrombin time（PT）， activated partial clotting enzyme live time（APTT），fibrinogen（Fib），D ⁃ dimer，antithrombin Ⅲ（AT Ⅲ）activity， activity of protein C（PC），protein S（PS）activity and serum CysC were collected and compared in the two groups. Univariate and multivariate logistic regression were used to analyze the risk factors affecting the prognosis ofpatients with septic AKI. And receiver operating characteristic（ROC）curve was drawn to evaluate the prognostic value of related indicators. Spearman correlation analysis was used to analyze the correlation between coagulation function index and serum CysC. Results All the 78 patients with septic AKI were included in the final analysis， including 55 males（70.51%）and 23 females（29.49%），with a ratio of 2.39∶1. The age ranged from 19 to 86，and the average age was（59.3 ± 16.2）. Thirty⁃six patients died after 28 days，with a fatality rate of 46.2%. Univariate analysis showed that the score of PT，APTT，D⁃dimer，serum CysC and APACHEⅡ in death group were signifi⁃ cantly higher than those in the survival group［PT（S）：18.0 ± 2.3 vs. 16.3 ± 2.9，APTT（S）：42.7 ± 7.1 vs. 38.1 ± 7.1，D⁃dimer（mg/L）：6.8（5.6，9.7）vs. 5.5（3.0，8.7），CysC（mg/L）：3.1 ± 1.4 vs. 1.9 ± 1.0，APACHEⅡscore： 26.1 ± 5.7 vs. 19.2 ± 4.4，both P < 0.01）. Fib and PLT in the death group were significantly lower than those in the survival group［Fib（g/L）：1.7（1.4，2.1）vs. 2.8（1.8，3.7），PLT（× 109 /L）：81.9 ± 32.8 vs. 128.7 ± 64.6，both P < 0.01］. Sex，age，past medical history，ATⅢ，PS and PC in the two groups showed no significant difference（All P > 0.05）. Multivariate logistic regression analysis showed that Fib，PLT，serum CysC and APACHEⅡ score were independent risk factors for the prognosis of septic AKI patients［odds ratio（OR）and 95% confidence interval （95%CI）respectively were 0.24（0.09 ~ 0.67），0.97（0.95 ~ 0.99），2.28（1.06 ~ 5.38），1.40（1.14 ~ 1.72）All P < 0.01］. ROC curve analysis showed that the area under ROC curve（AUC）of APACHEⅡ score，Fib，serum CysC and PLT for predicting mortality on 28 days of sepsis AKI was 0.84，0.77，0.76 and 0.75，respectively （All P < 0.05）. The predictive value of the combination of the 4 indexes（AUC = 0.95）was better than that of the single index（P < 0.05）. Correlation analysis showed that PT，APTT and CysC were significantly positively corre⁃ lated（r value was 0.31，0.49，respectively P < 0.01）. Conclusion Fib，PLT，serum CysC and APACHEⅡ score can be used as prognostic indicators for patients with septic AKI.

Key words:

sepsis, acute kidney injury, fibrinogen, serum cystatin C