| Objective: The effect of continuous renal replacement therapy(CRRT)on the prognosis of patients was compared between AKI stage 2 and AKI stage 3.The effects of AKI biomarkers at different stages on the timing and prognosis of CRRT initiation in critically ill patients were compared.Methods: From June 2017 to February 2018,a single-center,prospective observational study was conducted in the ICU of the Fourth Hospital of Hebei Medical University.Thirty critical patients undergoing CRRT and AKI were consecutively selected and divided according to the KDIGO guidelines.For AKI stage 2 and AKI stage 3 groups.All enrolled patients recorded basic vital signs and mechanically ventilated patients recorded their ventilator parameters.Take urine and blood samples before CRRT.After centrifugation,1 ml of supernatant was collected and frozen in a refrigerator at-80°C.After all blood and urine samples were collected,blood and urine specimens were subjected to neutrophil gelatinase-associated lipid transport in February 2018.The concentration of protein(NGAL),kidney injury molecule-1(KIM-1),and interleukin-18(IL-18)were measured.Cystatin C(s-Cys C)and serum creatinine(SCr)concentrations were measured in our biochemical laboratory.Patients were followed up for 28 days on the telephone.Results:1.Patient enrollment process and groupingA total of 38 patients were screened in this study.A total of 30 patients were eventually included.Among them,12 cases that conform to the KIDGO guide definition AKI stage 2 and 18 cases that have AKI stage 3.2.Comparison of general clinical data between AKI stage 2 and AKI stage 3 patientsThere was no statistical difference in basic medical characteristics such as gender,age,height,weight,et al.between AKI stage 2 and AKI stage 3 groups(P>0.05).3.Comparison of AKI biomarkers between AKI stage 2 and AKI stage 3Compared with the AKI 3 group,the AKI stage 2 group had higher concentrations of s-CysC,p-NGAL,u-KIM-1 and p-KIM-1(P<0.05).No other biomarkers were found between the two groups(P>0.05).4.Evaluation of the predictive value of biomarkers for 28-day mortality in patients with AKIThe area under the ROC curve(AUC)for s-CysC,p-NGAL,u-KIM-1,and p-KIM-1 for 28-day mortality in patients with AKI was 0.717,0.705,0.741,and 0.692,respectively;this study also calculated s-Cys C,p-NGAL,u-KIM-1,and p-KIM-1 predicted the 28-day mortality of AKI patients at 2.18 mg/L,4626.4 pg/ml,7104.52 pg/ml,and 91.55 pg/ml,respectively.5.Comparison of the relationship between the timing of CRRT initiation and prognosis in renal injury biomarkers30 patients were divided into the group above the cut off value and the group below the cut off value with the renal functional biomarker s-CysC and the renal damage biomarkers p-NGAL and u-KIM-1.The 28-day mortality was lower in the lower group of markers of kidney damage.CRRT time was significantly shorter in the lower group of renal functional markers.12 patients in the AKI stage 2 group were divided into subgroups that were greater than the cut off value and those that were less than the cut off value,using the p-NGAL and u-KIM-1 biomarkers for kidney injury.There was a statistical difference in the 28-day mortality between the two groups.6.Comparison of prognosis between AKI stage 2 and AKI stage 3The 28-day all-cause mortality rate was 16.7% in the AKI phase 2 group and 66.7% in the AKI phase 3 group(P=0.011).The renal function recovery rate was higher in the AKI stage 2 group than in the AKI stage 3 group(P=0.007).CRRT time was significantly shorter in patients with AKI stage 2(P=0.04).There was no significant difference in hospitalization time between the two groups.The median survival time in the AKI phase 2 group was significantly longer(109 days vs.34 days,P=0.024).Conclusion:1.For critically ill patients with AKI,early(AKI2)initiation of RRT can significantly reduce 28-day mortality and increase median survival time.2.s-CysC,p-NGAL and u-KIM-1 have a higher predictive value for the prognosis of AKI patients.3.The biomarkers of renal injury p-NGAL and u-KIM-1 direct the AKI 2 stage patients timing of CRRT to reduce the 28-day mortality and accelerate the recovery of renal function. |
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