Study On The Early Diagnosis Value Of NGAL,Cys-C And CRE In Acute Kidney Injury Caused By Hemorrhagic Shock

ObjectiveTo explore the clinical value of neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(Cys-C),and creatinine(CRE)in the early diagnosis of acute kidney injury(AKI)caused by hemorrhagic shock(HS).MethodsA total of 82 cases of HS diagnosed due to traumatic hemorrhage in the central ICU and emergency ICU of a tertiary hospital from October 2019 to January 2021 were collected;4 cases were automatically discharged due to hospitalization for less than 24 hours and were excluded;among 78 cases,72 cases without AKI(CRE<120umol/L)were selected at admission;the collected data included: basic information(name,gender,age,etiology,vital signs at admission),length of stay,laboratory test indicators(liver function),Renal function,blood coagulation,blood routine);among 72 case data,64 cases with complete records of serum NGAL,Cys-C and CRE on the day of admission and1 d,2d,and 3d after admission were selected as the research objects.Patients were divided into AKI group and non-AKI group according to whether the creatinine level after admission was 1.5 times or more than the baseline level.The chi-square test was used to compare the count data(gender,etiology)between groups,and the Mann-Whitney U test was used to compare the data between the groups(age,vital signs at admission,liver function,kidney function,blood coagulation,blood routine,length of stay).Pearson correlation analysis of the relationship between serum NGAL and Cys-C;ROC curve predicts the cut-off value of HS combined with AKI and the predictive value of combined detection for AKI;Kappa test compares the consistency between serum NGAL and Cys-C combined detection and the gold standard.P<0.05 indicates statistical significance.Results1.There are significant differences between the two groups of patients in heart rate,pulse,respiratory rate,systolic blood pressure,diastolic blood pressure,albumin(ALB),red blood cell count(RBC),hemoglobin(HB),platelet count(PLT)and other indicators.(P<0.05);2.The two groups of patients are in age,gender,etiology,body temperature,activated partial thromboplastin time(APTT),plasma prothrombin time(PT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil)and other items,the difference was not statistically significant(P>0.05);3.Comparing the two groups of patients in terms of age and length of hospitalization,the HS combined with AKI group was older and longer hospitalized than the non-AKI group,and the difference was statistically significant(P<0.05);4.Serum NGAL and Cys-C levels in the AKI group showed a gradual upward trend on the day of admission and 1 day after admission;the serum NGAL and Cys-C levels in the AKI group were higher than those in the non-AKI group on the day of admission,but there was no significant difference between the two groups(P>0.05);the serum NGAL and Cys-C levels in the AKI group were significantly higher than those in the non-AKI group at 1 day after admission,and there was a significant difference between the two groups(P<0.05);5.Pearson correlation analysis found that serum NGAL is positively correlated with Cys-C(P<0.05);6.In the AKI group,the number of patients with AKI on the day of admission,1 day after admission,2 days after admission,and 3 days after admission were 0,0,14 cases(70%),and 6 cases(30%),respectively.7.Taking the clinical diagnosis result as the gold standard,there were 19 true positive results in the combined test results of serum NGAL and Cys-C,and true negative results were 37 cases,false positive results were 7 cases,false negative results were 1 case,Kappa=0.731(P<0.05);8.The sensitivity of serum NGAL alone for detecting AKI was 80%(16/20),and the specificity was 88.6%(39/44);Cys-C alone has a sensitivity of 85%(17/20)and a specificity of 84.1%(37/44)for the detection of AKI;the combined detection of serum NGAL and Cys-C has a sensitivity of 95 %(19/20),the specificity is 84.1%(37/44),the sensitivity and specificity of the three detection methods are all high,cmpared with the sensitivity of the combined test and the two separate tests,the difference was statistically significant(P<0.05);there was no significant difference in the specificity of the combined detection compared with the two methods alone(P>0.05);9.The area under the ROC curve of serum CRE,NGAL and Cys-C levels in predicting the occurrence of AKI in HS is 0.752,0.850,0.913,respectively,and the area under the curve for combined detection of serum NGAL and Cys-C is 0.951;10.The sensitivity of NGAL in predicting the occurrence of AKI in HS is 80%,the specificity is 88.6%,the Youden index is 0.736,the cut-off value 257.5ng/ml,in AKI group,there were 16 cases(80%)with NGAL>257.5ng/ml,4 cases(20%)with NGAL<257.5ng/ml,5 cases(11.36%)with NGAL>257.5ng/ml in the non-AKI group,and there are 39 cases(88.64%)with NGAL<257.5ng/ml,there is a significant difference between the two groups(P<0.05);Cys-C has a sensitivity of 85% and a specificity of 84.1% in predicting the occurrence of AKI in HS,the Youden index is0.741,and the cut-off value is 1.65 mg/L,there were 17 cases(85%)with Cys-C>1.65mg/L in the AKI group,3 cases(15%)with Cys-C<1.65mg/L,and 7cases(15.91%)with Cys-C>1.65mg/L in the non-AKI group,37 cases(84.09%)with Cys-C<1.65mg/L,there was a significant difference between the two groups(P<0.05).Conclusion1.Hypotension,low ALB,low RBC,low HB and low PLT are more prone to AKI;2.The incidence of HS with AKI increases with age;3.HS combined with AKI will prolong the hospital stay;4.A significant increase in serum NGAL and serum Cys-C levels can indicate the occurrence of AKI,which can diagnose the occurrence of AKI earlier than serum CRE;5.The combined detection of serum NGAL and serum Cys-C has high sensitivity and specificity in HS combined with AKI.Compared with separate detection,it has obvious advantages in predicting AKI,and has greater reference value in the early diagnosis of HS combined with AKI.