The Predictive Value Of Blood Coagulation Index In Sepsis-associated Acute Kidney Injury

Background:sepsis refers to systemic inflammatory reactions with sepsis,which occur after host infections,resulting in a series of organ dysfunction.It is one of the main causes of death for patients in intensive care unit because of the rapid progression of the disease,but the difficulty of early organ injury assessment and delayed intervention.In Sepsis in a variety of complications,Sepsis associated with acute kidney injury(Sepsis – associated acute kidney injury,S-AKI)is a common complication of patients with Sepsis,leading to Sepsis patients medical costs increase,length of hospital stay and increased mortality,brings heavy burden to the society.Early prediction of the occurrence of S-AKI and accurate assessment of the severity of AKI can provide a basis for clinicians to make early medical intervention,which may reduce the mortality of patients.Due to technical and ethical limitations,current studies on the pathogenesis of S-AKI are mostly based on animal models,in vitro cell studies and pathological data of patients who died of S-AKI.The above studies believe that the pathogenesis of S-AKI is related to inflammatory factors and coagulation dysfunction.Therefore,this subject intends to study the detection level of coagulation indexes in the blood of sepsis patients and its relationship with S-AKI through clinical studies,so as to clarify whether coagulation indexes can be used as predictors of S-AKI occurrence,severity evaluation and prognosis prediction.Purpose:In this study,blood clotting indexes(including prothrombin time(PT),thrombin time(TT),activated partial thrombin time(APTT),fibrinogen(FIB),D-dimer,International standardized ratio(INR),and platelet count)of sepsis patients at the time of admission to the ICU were collected.Inflammatory markers(including C-reactive protein(CRP),Interleukin-6(IL-6),procalcitonin(PCT)),Renal function indicators(including Serum creatinine(Scr)and Serum cystatin C(Cys C))were collected,combined with blood lactic acid,SOFA score and APACHEII score.To study the predictive value of coagulation indexes for the occurrence of S-AKI and the evaluation of the severity of S-AKI,and to compare the predictive value of different indexes for 28 days of death in patients with S-AKI.It provides a new idea for the prevention and treatment of clinical S-AKI.Methods:In this study,blood clotting indexes(including prothrombin time(PT),thrombin time(TT),activated partial thrombin time(APTT),fibrinogen(FIB),D-dimer,International standardized ratio(INR),and platelet count)of sepsis patients at the time of admission to the ICU were collected.Inflammatory markers(including C-reactive protein(CRP),Interleukin-6(IL-6),procalcitonin(PCT)),Renal function indicators(including Serum creatinine(Scr)and Serum cystatin C(Cys C))were collected,combined with blood lactic acid,SOFA score and APACHEII score.To study the predictive value of coagulation indexes for the occurrence of S-AKI and the evaluation of the severity of S-AKI,and to compare the predictive value of different indexes for 28 days of death in patients with S-AKI.It provides a new idea for the prevention and treatment of clinical S-AKI.1.In the group that studied the prediction of S-AKI by coagulation index,51 patients diagnosed with S-AKI at admission were excluded according to KDIGO guidelines,and the creatinine and urine volume of the remaining 233 patients with sepsis at 2-7 days after admission were analyzed,and they were divided into AKI group(127 cases)and non-AKI group(106 cases)according to the presence or absence of AKI.Coagulation indexes(including PT,TT,APTT,FIB,D-dimer,INR,and platelet count),inflammatory indexes(including CRP,IL-6,PCT),renal function indexes(Scr,Cys C),blood lactic acid,SOFA score,and APACHEII score of the two groups were analyzed,and then the average levels were compared.For indicators with statistical differences,binary Logistic regression analysis was used to screen out the independent predictors of S-AKI occurrence.Finally,the predictive value of each independent predictor was evaluated.2.Blood creatinine and urine volume of 284 sepsis patients within 7 days after admission were analyzed in the group that studied coagulation indicators to assess S-AKI severity.According to KDIGOAKI staging criteria,284 patients with sepsis were divided into AKII stage(63 cases),AKIII stage(51 cases),AKIIII stage(64cases)and non-AKI group(106 cases).The coagulation index,SOFA score and APACHEII score of the four groups were compared.The correlation analysis of each coagulation index with SOFA score and APACHEII score was carried out.3.After 28 days of survival,178 patients with S-AKI were divided into survival group(103 cases)and death group(75 cases).The average level of blood coagulation index,SOFA score and APACHEII score of the two groups were compared,and the indicators with statistical differences were screened out by binary Logistic regression analysis.Finally,the predictive value of each independent risk factor was evaluated.Results:1.Value of coagulation index in predicting S-AKI occurrence Patients in AKI group and non-AKI group were compared.PT,APTT,D-dimer,INR,C-reactive protein,IL-6,procalcitonin,blood cystatin C,blood lactic acid,SOFA score and APACHE II score in AKI group were significantly higher than those in non-AKI group(P=0.000,P=0.000,P=0.000,P=0.010),P=0.000,P=0.000,P=0.000,P=0.000),the FIB and platelet count in AKI group were significantly lower than those in non-AKI group(P=0.000,P= 0.039).There was no significant difference in serum creatinine between the two groups at the time of admission to the ICU.Binary Logistic regression analysis showed that PT,APTT,INR,cystatin C and blood lactic acid were independent predictors of S-AKI(P=0.003,P=0.001,P=0.008,P= 0.000,P= 0.023).ROC curves of these five independent predictors were plotted,and the results showed that the areas under the curves of PT,APTT,INR,cystatin C and blood lactic acid were 0.891,0.798,0.655,0.877 and 0.817,respectively.2.Value of coagulation indexes in evaluating the severity of S-AKI The average level of coagulation index,SOFA score and APACHE II score of patients in non-AKI group,AKI stage 1,AKI stage 2 and AKI stage 3 were compared,and the results showed that the differences of the above indexes in different groups were statistically significant(P < 0.05),and then pairwise comparison between the four groups was conducted.The results showed that only PT was statistically significant between any two groups,and a correlation was found between coagulation index and SOFA score and APACHE II score.The correlation coefficients between PT,APTT and D-dimer and SOFA score were r=0.390,P=0.000,respectively.r=0.370,P=0.000;r=0.380,P=0.000,the correlation coefficients of PT,APTT,D-dimer and APACHE II score were r=0.323,P=0.000,respectively.r= 0.308,P=0.000;r=0.347,P=0.000.3.Value of different indicators in predicting 28-day death in S-AKI patients The average levels of each coagulation index,SOFA score and APACHE II score were compared between the survival group and the death group.The results showed that PT,APTT,D-dimer,INR,SOFA score and APACHE II score were significantly different between the two groups(P=0.000,P=0.000,P=0.000,P=0.000,P=0.042).Binary Logistic regression analysis was used to screen out the independent risk factors of 28-day death in S-AKI patients,including PT,INR,SOFA score(P=0.002,P=0.001,P=0.000).Then the ROC curve for predicting 28-day death by these independent risk factors was drawn,and the areas under the curve of PT,INR and SOFA scores were 0.786,0.741 and 0.764,respectively.Conclusion:1.Coagulation index PT,APTT,INR,renal function index cystatin C and blood lactic acid were independent predictors of S-AKI occurrence,among which coagulation index PT had the largest area under the curve.2.Coagulation indexes PT,APTT and D-dimer are valuable for evaluating the severity of S-AKI.3.PT,INR and SOFA scores were independent risk factors for 28-day death in S-AKI patients,among which PT had the largest area under the curve.