尿NGAL联合MEDS评分评估脓毒症合并急性肾损伤患者病情及预后

发布时间：2018-05-30 12:21

本文选题：尿 + 中性粒细胞明胶酶相关脂质运载蛋白　；参考：《第二军医大学学报》2017年02期

【摘要】：目的探讨尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合急诊脓毒症死亡风险(MEDS)评分在脓毒症合并急性肾损伤(AKI)患者病情及预后的评估价值。方法选取2013年1月至2015年12月入住上海中医药大学附属第七人民医院急诊科重症监护室且符合脓毒症合并AKI诊断标准的患者64例。依据2012年改善全球肾脏病预后组织(KDIGO)定义的AKI分期标准,将入选患者分为AKI 1期组(21例)、AKI 2期组(24例)和AKI 3期组(19例);依据28d内患者的存活情况,将患者分为死亡组(33例)和存活组(31例)。记录所有入选患者尿NGAL水平和MEDS评分,并比较不同AKI分期组以及存活组、死亡组的脓毒症患者尿NGAL水平和MEDS评分。绘制ROC曲线,分别评估尿NGAL、MEDS评分及两者联合对脓毒症合并AKI患者28d病死率的预测能力,采用约登指数找出最佳临界值。结果尿NGAL水平及MEDS评分随着脓毒症合并AKI分期的升高呈逐步上升趋势,3组之间差异有统计学意义(P0.01)。死亡组的尿NGAL水平、MEDS评分高于存活组,差异有统计学意义(P0.01)。ROC曲线分析显示尿NGAL及MEDS评分的曲线下面积(AUC)分别为0.885、0.841,最佳临界值分别为157.5ng/mL、10.5。尿NGAL联合MEDS评分预测28d病死率的AUC为0.936,敏感度91.4%,特异度89.2%,均优于单独使用尿NGAL或MEDS评分。结论尿NGAL及MEDS评分均可作为脓毒症合并AKI病情严重性的预测指标,两者联合对预后具有更大的评估价值。
[Abstract]:Objective to evaluate the value of urinary neutrophil gelatinase-associated lipid carrier protein (NGALs) combined with MEDS score in evaluating the condition and prognosis of patients with sepsis complicated with acute renal injury (AKI). Methods from January 2013 to December 2015, 64 patients who were admitted to the intensive care unit of the Emergency Department of the Seventh people's Hospital of Shanghai University of traditional Chinese Medicine and met the criteria for the diagnosis of sepsis and AKI were selected. According to the AKI staging criteria defined by KDIGO in 2012, the selected patients were divided into two groups: AKI stage 1 group (n = 21) and AKI stage 3 group (n = 19), according to the survival status of the patients within 28 days. The patients were divided into death group (n = 33) and survival group (n = 31). Urinary NGAL levels and MEDS scores were recorded in all patients, and urinary NGAL levels and MEDS scores in sepsis patients with sepsis were compared among different AKI staging groups, survival group and death group. The ROC curve was drawn to evaluate the urinary NGALM MEDS score and the predictive ability of the two methods to predict the fatality rate in patients with sepsis and AKI at 28 days. The best critical value was found by using the Jordan index. Results urinary NGAL level and MEDS score increased gradually with the increase of AKI stage of sepsis. There were significant differences among the three groups (P 0.01). The urinary NGAL level in the death group was higher than that in the survival group, and the difference was statistically significant (P 0.01). The area under the curve of urinary NGAL and MEDS score was 0.8850.841, and the best critical value was 157.5 ng / mL / L ~ (10.5), respectively. The AUC, sensitivity and specificity of urinary NGAL combined with MEDS score were 0.936, 91.4 and 89.2respectively, which were superior to those of urinary NGAL or MEDS score alone. Conclusion urinary NGAL and MEDS scores can be used as predictors of severity of sepsis complicated with AKI.
【作者单位】：第二军医大学长征医院急救科;上海中医药大学附属第七人民医院急诊科;
【分类号】：R459.7;R692

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