Diagnostic Value Of Neutrophil Gelatinase-associated Lipocalin,Kidney Injury Molecule-1 And Tissue Inhibitor Of Metalloproteinase-2 In The Early Time Of Septic-asociated Acute Kidney Injury

Objective:Sepsis is well known as life-threatening organ dysfunction due to a dysregulated host response to infection,it was not only common disease and frequently occurring disease in ICU,but also high mortality.Acute kidney injury was the most common and severe complication in patients with sepsis,especially in elderly patients,more than 50%of sepsis patients complicated with AKI,which is because of the diagnosis of AKI with a feature of delay,then it lead to missing the best time for treatment of in the early phase of sepsis-associated AKI.The aim of this study is to find other indicators to be use for early diagnosis of sepsis-associated AKI.Methods:In June 2015 to January 2016,patients with sepsis when addmisson to our hospital ICU was collected in this study,continuously observation for 72 hours to observe whether it is occurrence with AKI.The urine and blood samples were collected on admission and 12,24 and48 hours later.The levels of samples were detenrmined by enzyme-linked immunosorbent assay(ELISA).The changes of plasm and urine biomarkers expression level were compared among groups,and the correlation bettween expression levels of new biomarkers and values of Scr and SOFA score and APACHE II socre were analyzed.Furthemore,receiver operating characteristic curve(ROC)were described and area under the curve(AUC)were calculaced to evaluate the early diagnostic value of NGAL and KIM-1 and TIMP-2 in sepsis with AKI.Akl was defined by using the KDIGO(Kidney Disease Improving Global Outcome)criterion.All data were analyzed by SPSS20.O software.Results:38 patients were diagonsed to be complicatied with AKI in 90 sespsis patients(42.22%).In AKI group,the level of plasm and urine NGAL began to increase by T-18th after admitted in ICU(P<0.05)and reached the peak by T0h(P<0.05).Compared with the non-AKI sepsis group,the sepsis AKI group exhibited markedly higher levels of the plasm and urine NGAL levels at T-18h?T-12h?TOh?T24h?T48h respectively(P<0.01).In septic AKI group,the level of urine KIM-1 and TIMP-2 began to increase by T-18h after admitted in ICU(P<0.05)and reached the peak by T-12h(P<0.05).Compared with the non-AKI sepsis group,the sepsis AKI group exhibited markedly higher levels of the urine KIM-1 and TIMP-2 at T-18h?T-12h?T0h?T24h?T48h respectively(P<0.01).Before the diagnosis of AKI eighteen hours ago,the ROC-AUC of plasma NGAL,urine NGAL,urine KIM-1 and urine TIMP-2 were 0.84,0.95,0.76,0.87,respectively.Before the diagnosis of AKI twelve hours ago,the ROC-AUC of Plasma NGAL,urine NGAL,urine KIM-1 and urine TIMP-2 were 1,13 0.95 and 0.92?Urine TIMP-2 levels in AKI group is significantly positively correlated with APACHE ?socre(r=0.333,P<0.01;r=0.590,P<0.01).Conclusion:Plasma and urine NGAL,KIM-1,and TIMP-2 have potential to be used as diagnostic and predictive biomarkers for AKI in critically ill patients with sepsis.Urine TIMP-2 were positively correlated with APACHE ? score,which may reflect the severity of the disease.