The Value Of Urine Soluble Triggering Receptor Expressed On Myeloid Cells-1 In The Early Diagnosis Of Sepsis Associated Acute Kidney Injury

Objective: To assess the value of urine soluble triggering receptor expressed on myeloid cells-1(sTREM-1)in early diagnosis of sepsis associated acute kidney injury(AKI).Methods: This was a case-control study.A total of 62 patients with sepsis during November 2016 to June 2017 were collected,who were divided into non-AKI sepsis(n = 49)and AKI sepsis(n = 13)groups according to the serum creatinine(SCr)or urine output,sepsis with shock(n = 22)and sepsis without shock(n = 40)groups according to the presence of shock,survival(n = 47)and death(n = 15)groups according to the mortality.Twenty healthy children were recruited in control group,whose’ urine sTREM-1 were used as reference value.Urine and blood specimens were detected on admission(within 12h),at 24 h and 48 h after admission.Student’s t-test and Mann-Whitney U test were used for statistical analysis.Results:(1)On admission,the level of urine sTREM-1 were significantly higher in sepsis patients than in healthy controls [96.8(71.3,105.8)ng/L vs.68.6(60.6,71.1)ng/L;Z=4.708,P<0.05];(2)Comparing of sTREM-1 in different groups showed that the levels were higher in AKI sepsis patients than in the non-AKI ones(105.6±4.8 ng/L vs.86.2±18.2 ng/L;t=6.670,P<0.05),higher in the sepsis with shock group than in sepsis without shock group(98.0±11.3 ng/L vs.85.9±19.8 ng/L;t=3.059,P<0.05),and also higher in death group than in survival group(101.5±12.1ng/L vs.86.6±18.3ng/L;t=3.615,P<0.05).(3)The area under the receiver operating characteristic(AUROC)of urine sTREM-1 in predicting sepsis associated AKI was 0.814 [95%CI(0.708,0.920)],which was higher than that in predicting shock,increased serum creatinine,hyperlipidemia or hyperbilirubinemia(0.530,0.425,0.429 and 0.443,respectively).The optimal sTREM-1 cut-off point for predicting sepsis associated kidney injury was 96.5 ng/L,with specificity and sensitivity of 100.0% and 57.1%.(5)The odds ratio(OR)of urine sTREM-1 was 0.879 with a significance of 0.005 after adjusting shock,prognosis,serum creatinine,lactate and total bilirubin level,indicating that the urine sTREM-1 was an independent risk factor of sepsis associated AKI.Conclusion: Urine s TREM-1 can be used as an early diagnostic biomarker for sepsis associated AKI,with advantage of noninvasiveness and convenience.