The Predictive Value Of Urinary TIMP-2 And Serum Cys C In The Recent Renal Function Outcome Of Patients With SEPSIS AKI Who Underwent CRRT

Objective:To explore the predictive value of urinary TIMP-2 and serum Cys C in the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT.Methods:The patients with SEPSIS Acute kidney injury（AKI）who underwent Continuous renal replacement therapy（CRRT）were collected in the Intensive care unit（ICU）and emergency ICU of Chengde Central Hospital from October 2019 to January 2021.Patients were selected strictly following the inclusion and exclusion criteria,and 45 patients were collected.I divided them into group A and group B according to their recent renal function outcomes.The renal function outcome of patients in group A was good,while that in group B was poor.The criterion of good recent renal function outcome:Patients can stop RRT after 28 days of admitting,and estimated glomerular filtration rate（e GFR）was calculated using the formula of Modification of Diet in Renal Disease after 7 days of stopping RRT,e GFR≥15ml*min^-1*（1.73m²）^-1,Urine volume≥0.5 ml/（kg*h）.The criterion of poor recent renal function outcome:Patients still needed RRT after 28 days of admitting,or patients died.Recording patients’gender,age,site of infection,urinary tissue inhibitor of matrix metalloproteinase-2（TIMP-2）,serum cystatin C（Cys C）,creatinine,urine volume,and the worst values of mean arterial pressure,heart rate and white blood cell count within 24 hours before starting CRRT.Calculating acute physiology and chronic health evaluationⅡ（APACHE Ⅱ）by using the worst value of every index within 24 hours before starting CRRT.Urinary TIMP-2 detection kit was provided by Shanghai Hepai Biological Technology Limited Company,and other indexes were provided by the Laboratory Department of Chengde Central Hospital.SPSS 26.0 statistical analysis software was used.Age,creatinine,Cys C,TIMP-2,etc.of measurement data were tested for normality.Mean±standard deviation（x±s）was used to express normal distribution measurement data,and comparing the normal distribution measurement data between the two groups used the independent sample t test.Median（interquartile range）[M(P₂₅,P₇₅)]was used to express non-normal distribution measurement data,and comparing the non-normal distribution measurement data between the two groups used the Mann-Whitney U test.Gender,etc.of enumeration data were expressed as Frequency and percentage[n（%）],and Pearson chi-square test or continuity correction chi-square test was used for comparison between groups.The value of Creatinine,APACHE Ⅱ score,urinary TIMP-2,serum Cys C and their combinations in predicting the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT was evaluated by using the area under receiver operating characteristic（ROC）curve,and the cut-off value,sensitivity and specificity of Creatinine,APACHE Ⅱ score,TIMP-2,Cys C and their combinations were counted.P<0.05 was considered that the difference was statistically significant.Results:1.Comparison of general informationAmong the 45 patients with SEPSIS AKI who underwent CRRT,there were 25 cases of male and 20 cases of female.There were no statistically significant differences in gender,age,site of infection（pulmonary infection,urinary tract infection,abdominal infection）,heart rate,mean arterial pressure,white blood cell count between group A and group B（P>0.05）.The APACHE Ⅱ score,creatinine,urinary TIMP-2 and serum Cys C of group A were lower than those of group B,while the urine volume of group A was higher than that of group B,the differences were statistically significant（P<0.05）.2.The ROC curveThe value of Creatinine,APACHE Ⅱ score,urinary TIMP-2,serum Cys C within 24 hours before starting CRRT and their combinations in predicting the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT was evaluated by using the area under ROC curve,analysis is as follows:The area under ROC curve of Creatinine was applied to predict the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT was 0.676（95%CI:0.518-0.834,P<0.05）,the cut-off value was 175umol/L,which had a corresponding sensitivity of 69.6%and specificity of63.6%.The area under ROC curve of APACHE Ⅱ score was applied to predict the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT was 0.672（95%CI:0.515-0.829,P<0.05）,the cut-off value was 31.5,which had a corresponding sensitivity of 47.8%and specificity of81.8%.The area under ROC curve of TIMP-2 was applied to predict the recent renal function outcome of them was 0.720（95%CI:0.566-0.874,P<0.05）,the cut-off value was 109.57ng/m L,which had a corresponding sensitivity of78.3%and specificity of 72.7%.The area under the ROC curve of Cys C was applied to predict the recent renal function outcome of them was0.723（95%CI:0.573-0.873,P<0.05）,the cut-off value was 2.76mg/L,which had a corresponding sensitivity of 69.6%and specificity of 72.7%.The area under ROC curve of TIMP-2 combined with Cys C was 0.741（95%CI:0.595-0.888,P<0.05）,the sensitivity was 73.9%and specificity was72.7%.The area under the ROC curve of the combination of APACHE Ⅱ score,TIMP-2 and Cys C was 0.779（95%CI:0.642-0.915,P<0.05）,the sensitivity was87%and specificity was 63.6%.Conclusion:1.Urinary TIMP-2、serum Cys C、Creatinine、APACHE Ⅱ score have predictive value on the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT,and the predictive value of urinary TIMP-2、serum Cys C on the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT were better.2.The predictive value of the combination of urinary TIMP-2 and serum Cys C on the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT was better than that of a single index.3.The predictive value of the combination of APACHE Ⅱ score,urinary TIMP-2 and serum Cys C on the recent renal function outcome of patients with SEPSIS AKI who underwent CRRT was better than that of the single index and the combination of urinary TIMP-2 and serum Cys C.