Early Predictive Value Of Neutrophil Gelatinase-Associated Lipocalin,Product Of Insulin Like Growth Factor Binding Protein-7 And Tissue Inhibitor Of Metalloproteinase-2,Combined With Soluble Thrombomodulin In Septic-Asociated Acute Kidney Injury

Objective:This study is to sepsis patients as the research object,the common laboratory test indicators such as white blood cell count(WBC),percentage of neutrophils(neu%),platelet count(PLT),CRP,procalcitonin(PCT),creatinine,urinary NGAL,The product of urinary insulin-like growth factor binding protein-7 and tissue inhibitor of metalloproteinase-2:urinary[TIMP-2]×[IGFBP7]and plasma sTM levels were detected in sepsis patients,and the value of related indicators in early prediction of sepsis acute kidney injury was analyzed.Methods:From December 2019 to February 2021,40 patients with sepsis in the emergency department of our hospital were selected.According to KDIGO guidelines,patients with sepsis were divided into AKI group(n=10),non AKI group(n=30)and healthy control group(n=20).General information of patients,including age,gender,underlying chronic diseases,source of infection and so on,was collected.The general vital signs,24-hour urine volume,blood routine,liver,kidney,electrolyte and blood gas analysis were recorded.The sequential organ failure score(SOFA score)and acute physiology and chronic health score(APACHE II score)were calculated.5ml of blood and 5-10ml of urine were collected from the ipsilateral median cubital vein at 0h and 24h after the diagnosis,and new biomarkers of renal injury such as urinary NGAL,urinary[TIMP-2]×[IGFBP-7]were detected and plasma sTM.All the data were analyzed by IBM SPSS 25.0,and the mean or median values of different parameters were compared.The risk of acute kidney injury in patients with sepsis and the influencing factors were analyzed by logistic regression analysis.The receiver operating characteristic curve was drawn to predict the early predictive value of three renal injury markers in sepsis acute kidney injury.Results:40 patients with sepsis were included in this study.Compared with non AKI group,the platelet count,infectious indexes such as PCT,CRP and renal function creatinine in AKI group had certain clinical statistical significance.Compared with non AKI group,urinary NGAL and urinary[TIMP-2]×[IGFBP-7]were significantly higher in AKI group than in non AKI group.Urinary[TIMP-2]×[IGFBP-7]and plasma sTM can be used to predict the early diagnosis of sepsis related acute kidney injury.Among them,at 0 hours of diagnosis of AKI,urinary[TIMP-2]×[IGFBP-7]had higher diagnostic accuracy(AUC=0.834,95%CI:0.72,0.95),AUC was 0.834,diagnostic threshold was 0.38(ng/ml)~2,diagnostic sensitivity and specificity were 0.62 and 0.90,respectively.After 24 hours,the combined detection of the related indicators had higher diagnostic accuracy(AUC=0.873,95%CI:0.77,0.98),diagnostic sensitivity and specificity were 0.75 and 0.88,respectively.Conclusion:In this study,we found that urinary[TIMP-2]×[IGFBP-7]and plasma sTM can predict the early diagnosis of sepsis related acute kidney injury.The combined detection of the three markers can improve the diagnosis effect,so as to help clinicians carry out early warning and intervention on sepsis related acute kidney injury.