Correlation analysis of HMGB1 and MCP-1 levels and prognosis of patients with sepsis combined with AKI

doi:10.11958/20242035

Abstract

Abstract:

Objective To analyze the correlation between the levels of high mobility group protein B1 (HMGB1), monocyte chemotactic protein-1 (MCP-1) and the prognosis of patients with sepsis combined with acute kidney injury (AKI). Methods A total of 100 patients with sepsis combined with AKI treated with continuous renal replacement therapy (CRRT) were included in this study and clinical data before treatment were collected. The levels of HMGB1 and MCP-1 were detected by enzyme-linked immunosorbent assay before and after CRRT treatment. Follow-up began on the day after the end of CRRT treatment, and the end point of follow-up was death or survival within 30 days. Patients were divided into the death group (31 cases) and the survival group (69 cases) according to survival status. Cox regression was used to analyze the relationship between HMGB1 and MCP-1 and death within 30 days after CRRT in patients with septic AKI. Receiver operating characteristics (ROC) curve was used to analyze the prognostic value of HMGB1 and MCP-1 in patients with sepsis combined with AKI after CRRT. Resluts The sequential organ failure (SOFA) scores, acute physiology and chronic health Ⅱ (APACHE Ⅱ) scores were lower in the survival group than those in the death group (P<0.05). After CRRT treatment, HMGB1 and MCP-1 levels were lower in the survival group than those in the death group (P<0.05). Cox regression analysis showed that SOFA score, APACHE Ⅱscore, HMGB1 and MCP-1 increase after treatment were risk factors for death in patients with sepsis complicated with AKI. ROC curve analysis showed that the AUC of SOFA score, APACHE Ⅱ score, combined diagnosis of HMGB1 and MCP-1 after treatment was 0.973, which was significantly higher than that of single detection (P<0.05). Conclusion The increased levels of HMGB1 and MCP-1 in peripheral blood after treatment are independent risk factors for 30-day death in patients with sepsis complicated with AKI after CRRT treatment, and the combined prognostic value is high.

Key words: sepsis, acute kidney injury, continuous renal replacement therapy, prognosis, HMGB1 protein, MCP-1

CLC Number:

R631，R692.5

Figures/Tables 5

References 16

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组别	n	年龄/ 岁	性别（男/女）		BMI/ （kg/m²）	SOFA 评分/分		APACHEⅡ 评分/分	CRRT持续时间/d		Scr/ （μmol/L）	CRP/ （mg/L）	BUN/ （mmol/L）		eGFR/[mL/ （min·1.73 m²）]
生存组	61	54.33±7.01	32/29		25.67±4.10	10.67±1.24		10.92±2.10	5.0（4.0，8.0）		344.79±115.04	199.96±48.49	24.72±6.99		20.95（15.04，31.19）
死亡组	39	56.46±6.94	26/13		25.13±3.96	12.33±1.06		14.74±2.70	6.0（4.0，8.0）		387.23±126.90	207.23±51.26	21.96±6.63		20.54（10.00，29.78）
t、Z或χ²		1.490	1.971		0.652	6.926^＊＊		7.934^＊＊	0.089		1.728	0.714	1.965		0.866
组别		ALT/（U/L）		AST/（U/L）		PCT/（ng/L）		WBC/（×10⁹/L）		PLT/（×10⁹/L）			APTT/s	PT/s			INR
生存组		39.56±9.96		55.91±11.16		12.35±4.47		14.26±4.96		125.64（87.89，166.90）			38.79±9.93	15.15±2.26			1.45（0.96，1.79）
死亡组		42.41±10.12		59.73±12.38		11.56±4.93		13.84±6.73		144.51（108.07，173.91）			41.25±10.10	15.60±2.19			1.44（0.78，1.77）
t或Z		1.387		1.595		0.819		0.351		1.572			1.201	0.983			0.339
吃组别			ALB/ （g/L）		TBIL/ （μmol/L）		血清钠/ （mmol/L）		血清钾/ （mmol/L）		血清钙/（mmol/L）	血清磷/（mmol/L）			糖尿病	冠心病		肝炎
生存组			31.91±8.22		34.69±4.50		137.36±7.86		4.41±0.96		2.01±0.33	1.51±0.23			18	22		12
死亡组			29.63±7.96		33.12±5.17		139.23±5.21		4.70±0.85		1.92±0.50	1.54±0.27			15	19		10
t或χ²			1.364		1.617		1.311		1.541		1.098	0.595			0.863	1.574		0.494

组别	n	年龄/ 岁	性别（男/女）		BMI/ （kg/m²）	SOFA 评分/分		APACHEⅡ 评分/分	CRRT持续时间/d		Scr/ （μmol/L）	CRP/ （mg/L）	BUN/ （mmol/L）		eGFR/[mL/ （min·1.73 m²）]
生存组	61	54.33±7.01	32/29		25.67±4.10	10.67±1.24		10.92±2.10	5.0（4.0，8.0）		344.79±115.04	199.96±48.49	24.72±6.99		20.95（15.04，31.19）
死亡组	39	56.46±6.94	26/13		25.13±3.96	12.33±1.06		14.74±2.70	6.0（4.0，8.0）		387.23±126.90	207.23±51.26	21.96±6.63		20.54（10.00，29.78）
t、Z或χ²		1.490	1.971		0.652	6.926^＊＊		7.934^＊＊	0.089		1.728	0.714	1.965		0.866
组别		ALT/（U/L）		AST/（U/L）		PCT/（ng/L）		WBC/（×10⁹/L）		PLT/（×10⁹/L）			APTT/s	PT/s			INR
生存组		39.56±9.96		55.91±11.16		12.35±4.47		14.26±4.96		125.64（87.89，166.90）			38.79±9.93	15.15±2.26			1.45（0.96，1.79）
死亡组		42.41±10.12		59.73±12.38		11.56±4.93		13.84±6.73		144.51（108.07，173.91）			41.25±10.10	15.60±2.19			1.44（0.78，1.77）
t或Z		1.387		1.595		0.819		0.351		1.572			1.201	0.983			0.339
吃组别			ALB/ （g/L）		TBIL/ （μmol/L）		血清钠/ （mmol/L）		血清钾/ （mmol/L）		血清钙/（mmol/L）	血清磷/（mmol/L）			糖尿病	冠心病		肝炎
生存组			31.91±8.22		34.69±4.50		137.36±7.86		4.41±0.96		2.01±0.33	1.51±0.23			18	22		12
死亡组			29.63±7.96		33.12±5.17		139.23±5.21		4.70±0.85		1.92±0.50	1.54±0.27			15	19		10
t或χ²			1.364		1.617		1.311		1.541		1.098	0.595			0.863	1.574		0.494

组别	n		HMGB1/（μg/L）
组别	n		治疗前		治疗后		t
生存组	61		141.67±33.07		109.41±25.23		6.046^＊＊
死亡组	39		153.92±34.57		127.60±27.64		3.869^＊＊
t			1.775		3.388^＊＊
组别		MCP-1/（pg/L）
组别		治疗前		治疗后		t
生存组		121.23±28.21		104.49±21.23		3.717^＊＊
死亡组		130.96±29.10		118.73±22.04		2.008
t		1.662		3.226^＊＊

组别	n		HMGB1/（μg/L）
组别	n		治疗前		治疗后		t
生存组	61		141.67±33.07		109.41±25.23		6.046^＊＊
死亡组	39		153.92±34.57		127.60±27.64		3.869^＊＊
t			1.775		3.388^＊＊
组别		MCP-1/（pg/L）
组别		治疗前		治疗后		t
生存组		121.23±28.21		104.49±21.23		3.717^＊＊
死亡组		130.96±29.10		118.73±22.04		2.008
t		1.662		3.226^＊＊

变量	β	SE	Wald χ²	P	HR	95%CI
治疗后MCP-1	0.016	0.008	4.474	0.034	1.016	1.001~1.031
治疗后HMGB1	0.022	0.007	10.594	0.001	1.022	1.009~1.036
APACHEⅡ评分	0.195	0.048	16.244	<0.001	1.216	1.105~1.337
SOFA评分	0.757	0.163	21.587	<0.001	2.133	1.549~2.935