Objective To investigate the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL), serum cystatin C (Cys-C) and kidney injury molecule-1 (KIM-1) on early continuous renal replacement therapy (CRRT) in sepsis patients with acute kidney injury (AKI). Methods 68 patients with sepsis and AKI who underwent CRRT in the Nephrology Department of our hospital from July 2017 to July2018 were selected and followed up for 30 days after CRRT. Patients were divided into two groups according to the survival status, namely survival group (n = 32) and the death group (n = 36). The levels of NGAL, KIM-1 and Cys-C were compared between the two groups, and their correlation was determined by Pearson correlation analysis. The risk factors of 30-day mortality among the selected patients were analyzed by multivariate logistic regression. Then the ROC curve analysis was used to compare the value of NGAL, KIM-1, Cys-C in the prediction of renal function outcome and mortality in patients with sepsis and AKI within 30 days. Results The levels of NGAL, KIM-1 and Cys-C in the death group were significantly higher than those in the survival group (P ＜ 0. 05). NGAL was positively correlated with KIM-1 and Cys-C (P ＜ 0. 05).NGAL, KIM-1, and Cys-C were risk factors for 30-day mortality in patients with AKI (P ＜ 0. 05). The predictive value of combined detection of NGAL, KIM-1 and Cys-C for the prognosis of renal function in sepsis patients with AKI undergoing CRRT was significantly better than that of single detection (P ＜ 0. 05). The predictive value of combined detection of NGAL, KIM-1 and Cys-C for short-term mortality of sepsis patients with AKI undergoing CRRT was significantly better than that of single detection (P ＜ 0. 05). Conclusion NGAL, KIM-1, and Cys-C are sensitive indicators for predicting the prognosis of sepsis with AKI. The combined detection of the three can further improve the predictive ability of short-term prognosis of CRRT in patients with sepsis and AKI.%目的 探讨脓毒症急性肾损伤(AKI)中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(Cys-C)、肾损伤分子1(KIM-1)联检对持续性肾脏替代治疗(CRRT)预后的预测价值.方法 回顾性选择2017年7月至2018年7月潍坊市中医院肾内科收治的需行CRRT的脓毒症合并AKI患者68例作为研究对象.从CRRT起随访30 d,记录患者在此期间生存情况,根据生存情况分为存活组(n=32)与死亡组(n=36).比较两组患者NGAL、KIM-1、Cys-C水平,采用Pearson相关分析检验NGAL与KIM-1、Cys-C的相关性,多因素Logistic回归分析法分析68例患者30 d死亡率的危险因素,ROC曲线分析比较NGAL、KIM-1、Cys-C对脓毒症合并AKI患者30 d内肾功能转归及病死率的预测价值.结果 死亡组患者NGAL、KIM-1、Cys-C水平显著高于存活组,有统计学差异(P ＜0.05);NGAL与KIM-1、Cys-C均呈正相关(P ＜0.05);NGAL、KIM-1、Cys-C为AKI患者30 d死亡率的危险因素(P ＜0.05);NGAL、KIM-1、Cys-C联合检测对行CRRT的脓毒症合并AKI患者近期肾功能转归的预测价值明显优于单独检测NGAL、KIM-1、Cys-C(P ＜0.05);NGAL、KIM-1、Cys-C联合检测对行CRRT的脓毒症合并AKI患者近期病死率的预测价值明显优于单独检测NGAL、KIM-1、Cys-C(P ＜0.05).结论 NGAL、KIM-1、Cys-C是预测脓毒症合并AKI患者预后的敏感指标,三者联合检测可进一步提高对脓毒症合并AKI患者CRRT短期预后的预测能力.
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