The Early Prediction Value Of Urinary α 1-microglobulin And Urinary N-acetyl-β-d-glucosaminidase In Sepsis-induced Acute Kidney Injury

Objective:Sepsis is a systemic inflammatory response caused by hidden or known infection factors.Sepsis is still a medical problem harmful to human life,which will increase mortality and deteriorate prognosis.Every year,the number of patients with severe sepsis in the world is more than 10 million/year,and nearly 15,000 patients die every day.The number of sepsis cases in the United States is about 750,000,and the prevalence of severe sepsis infection in China is close to 10%.When sepsis patients are complicated with acute kidney injury,it will lead to an increase in mortality.According to the latest guidelines,the standard of acute kidney injury is still serum creatinine and urine volume,but it has been considered as a dull and inaccurate indicator.New biomarkers of acute kidney injury are currently a research hotspot.This paper aims to explore the early predictive value of urinary α1-microglobulin and urinary N-acetyl-β-D-glucosaminidase for acute renal injury in sepsis.Methods:60 patients with sepsis/septic shock were selected and divided into sepsis acute kidney injury group(26 cases)and sepsis non acute kidney injury group(34 cases)according to the grouping criteria(whether renal injury occurred within 7 days after the diagnosis of sepsis).Urine and blood samples were collected at admission(before treatment)and at the time of AKI,and the following data were measured:① Urinary α1-microglobulin(α1-M),urinary β2-microglobulin(β2-M),urinary N-acetyl-β-D-glucosaminidase(NAG),urinary retinol binding protein(RBP),urinary microalbumin(MA),urinary creatinine(UCR),serum creatinine(SCR),blood urea nitrogen(BUN),white blood cells(WBC),serum interleukin-6(IL-6),procalcitonin(PCT);②Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)were obtained within the first 24 hours of ICU and when kidney injury occured according to the collected physiological parameters and laboratory results;③Patients’ gender,age,body temperature,mean arterial pressure(MAP)and heart rate were collected;④Record the days of hospitalization and survival in intensive care unit(ICU);⑤The types of infection,the use of mechanical ventilation,the use of vasoactive drugs,the use of diuretics,and the use of continuous renal replacement therapy(CRRT)were collected.SPSS 26.0(Chinese version)and MedCalc18.2.1 statistical software were used for statistical analysis.P<0.05 was statistically significant.Result:1.There were statistically significant differences in body temperature,mechanical ventilation,vasoactive drugs,diuretics and CRRT between sepsis AKI group and non-AKI group(P<0.05).2.There were no significant differences in gender,age,heart rate,MAP,infection site,WBC,PCT,urine UCR and ICU stay between sepsis AKI group and sepsis non-AKI group(P>0.05).3.There were statistically significant differences in SCRP,IL-6,urinary α1-M,urinary β2-M,urinary NAG,urinary MA,urinary RBP,SCR,BUN,APACHE Ⅱscores and SOFA scores between the sepsis AKI group and the sepsis non-AKI group(P<0.05).4.The area under the curve(AUC)of urine α1-M used to predict whether sepsis had acute kidney injury was 0.864,the sensitivity was 80.7/7%,and the specificity was 79.41%.The AUC of urinary NAG for predicting acute renal injury in sepsis was 0.827,the sensitivity was 76.92%,and the specificity was 85.29%.The AUC of urine β2-M for predicting acute renal injury in sepsis was 0.735,the sensitivity was 80.77%and the specificity was 58.82%.The AUC of urinary MA in predicting acute renal injury in sepsis was 0.693,the sensitivity was 57.69%and the specificity was 88.24%.The AUC of urinary RBP was 0.705,the sensitivity was 92.31%,and the specificity was 47.06%.The AUC of SCR was 0.824,the sensitivity was 65.38%,and the specificity was 88.24%.5.The urinary α1-M and NAG with high prediction rate were combined,with AUC of 0.916,sensitivity of 88.46%and specificity of 79.41%.6.There was a statistically significant difference in the 7-day survival rate between the sepsis AKI group and the sepsis non-AKI group(P<0.05),while there was no statistically significant difference in the 28-day survival rate(P>0.05).However,the 28-day mortality in acute renal injury group was 57.7%,which was higher than 41.2%in non-acute renal injury group.Conclusion:The expression of α1-M and NAG in urine of sepsis-related AKI patients was higher than that of sepsis patients without acute kidney injury.The increase of urinaryα1-M and NAG levels has an early warning significance for sepsis-related AKI,and the combined prediction of urinary α1-M and urinary NAG in patients with sepsis is more valuable than single prediction.