Prognostic Value Of Urinary NGAL Combined With MEDS Score In Patients With Sepsis Induced Acute Kidney Injury

Objective Through the detection of Levels of urinary neutrophil gelatinase-associated lipocalin(NGAL)in urine of the patients enrolled and effective mortality jn emergency department sepsis(MEDS)score for patients,to explore the value of evaluation of urinary NGAL combined with MEDS score in the early stage of sepsis complicated with acute kidney injury(AKI)to The value of the patient’s condition and prognosis.Methods 64 patients,selected who consistent with the criteria for sepsis with acute kidney injury criteria were admitted to the emergency department of the Affiliated People’s Hospital of Shanghai University of Traditional Chinese Medicine from January 2013 to December 2015。 According to the diagnostic criteria of acute kidney injury,which was defined in 2012 to Kidney Disease: Improving Global Outcomes(KDIGO),the patients were divided into AKI I group(21 cases),AKI II group(24 cases)and AKI III group(19 cases).According to the survival of patients within 28 days,all patients were divided into survival group(31 cases)and death group(33 cases).The survival difference between the three groups was analyzed by the survival curve which drawn by Kaplan-Meier method.The urinary NGAL level and MEDS score of all the patients were recorded,and the urinary NGAL level and MEDS score were compared between the different AKI staging group and the survival group and the death group.Correlation analysis was made between NGAL level and MEDS score.Receiver operating characteristic(ROC)curve,respectively,to assess the predictive capacity of urinary NGAL,MEDS score and combination of sepsis with acute kidney injury were 28 day mortality,the Youden index to find the optimal critical value.Results:1.Three groups of different stages of sepsis and urine levels of NGAL and MEDS in patients with acute kidney injury with injury severity score in patients with acute kidney complicated with sepsis showed a gradual upward trend,the difference was statistically significant(P<0.01).2.The 28 day mortality rate of sepsis patients with AKI III was significantly higher than that of patients with stage AKI I and AKI II.There was significant difference in mortality between the three groups(P = 0.038,<0.05).3.Kaplan-Meier survival analysis showed that there were significant differences between the three groups of patients with sepsis complicated with acute kidney injury(Log Rank test,12.61,P<0.05).4.64 cases of sepsis with acute kidney injury in patients died within 28 days of 33 cases,the survival of 31 cases,the mortality rate was 51.6%.5.The average age of the death group was significantly higher than that of the survival group(P<0.05).The urinary NGAL level and MEDS score in the death group were higher than those in the survival group,the difference was statistically significant(P<0.01).6.There was a positive correlation between the urinary NGAL level and MEDS score(r=0.911 P<0.01).7.ROC curve analysis showed that the area under the curve of urine NGAL and MEDS score(AUC)were 0.885 and 0.841,and the optimal critical value was 157.5ng/ml and 10.5 respectively.The urinary NGAL predicted 28 day mortality rate sensitivity was 75.8%,specificity was 83.9%;the MEDS score predicted 28 day mortality rate sensitivity was 89.9%,specificity was 67.7%;the goodness of fit of Hosmer and Lemeshow,the prediction probability(P)as the analysis index,urinary NGAL combined with MEDS score in the prediction of 28 days the mortality rate of the best,the AUC reached 0.936,the sensitivity was 91.4%,specificity was 89.2%.Conclusion 1.The urine NGAL level and MEDS score in patients with sepsis and acute kidney injury in the evaluation of the prognosis have synergy,and there is a positive correlation between the two.2.In predicting the 28 day mortality rate of sepsis patients with acute kidney injury,the urine NGAL level and MEDS score had some clinical predictive value,and the predictive value of urinary NGAL level was slightly higher than that of MEDS score.3.The level of urinary NGAL level and MEDS score were the highest sensitivity and specificity in the early evaluation of the prognosis of these patients.4.The optimal threshold value of urinary NGAL level and MEDS score may provide some clinical reference for the early evaluation of the severity and prognosis of sepsis complicated with acute kidney injury.