The value of combined detection of PCT, IL-6 and CysC for the diagnosis and prognosis assessment of septic acute kidney injury

doi:10.11958/20240835

Abstract

Abstract:

Objective To explore the diagnostic and prognostic values of procalcitonin (PCT), interleukin 6 (IL-6) and cystatin C (CysC) combined detection in sepsis acute kidney injury (AKI).Methods A total of 100 patients with sepsis were divided into the AKI group (n=56) and the non AKI group (n=44) according to the occurrence of AKI. The prognosis of AKI patients was followed up, and patients were divided into the survival group (n=32) and the death group (n=24) according to the presence or absence of death. Enzyme-linked immunosorbent assay (ELISA) was used to detect PCT, IL-6 and CysC in different groups of patients. The Acute Physiological Function and Chronic Health Status Score (APACHEⅡ) was used to assess the condition of illness. ROC curve was used to analyze the predictive values of PCT, IL-6 and CysC in the diagnosis and death of sepsis combined with AKI.Results The male ratio, age, hypertension with diabetes ratio, APACHE Ⅱ score, serum creatinine (Scr), PCT, IL-6 and CysC levels were higher in the AKI group than those in the non AKI group, and the ratio of complications and onset time were lower in the AKI group than those in the non AKI group (P<0.05). The ROC curve results showed that the area under the curve (AUC) of PCT, IL-6, and CysC combined for the diagnosis of sepsis complicated with AKI was 0.859, with a sensitivity of 91.07% and a specificity of 90.91%. The combined diagnostic efficacy was better than that of a single indicator. The APACHE Ⅱ score, PCT, IL-6 and CysC levels were higher in the death group than those in the survival group (P<0.05). The ROC curve results showed that the AUC, sensitivity and specificity of PCT, IL-6 and CysC combined in predicting mortality in sepsis patients with AKI were 0.847, 91.67% and 87.50%, respectively. The combined predictive efficacy was better than that of single indicator.Conclusion The combination of PCT, CysC and IL-6 indicators is more valuable in diagnosing and predicting prognosis of sepsis with AKI.

Key words: sepsis, acute kidney injury, prognosis, procalcitonin, interleukin-6, cystatin C

CLC Number:

R692

Figures/Tables 6

References 26

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组别	n	性别（男/女）	年龄/ 岁	BMI/ （kg/m²）	感染部位^①	合并症^②
非AKI组	44	25/19	56.08±18.25	22.29±2.96	4/30/3/7	4/5/3/32
AKI组	56	43/13	65.14±15.87	22.55±3.10	1/43/8/4	11/8/14/23
χ²或t		4.515^＊	2.652^＊	0.425	5.850	11.272^＊
组别		发病时间/d	机械通气	感染性休克	APACHEⅡ 评分/分	心率/ （次/min）
非AKI组		9.34±2.52	23（52.27）	25（56.82）	18.00±7.03	103.25±21.04
AKI组		5.80±1.60	32（57.14）	42（75.00）	24.63±7.08	108.59±22.40
χ²或t		8.551^＊	0.236	3.684	4.663^＊	1.215
组别		SBP/ mmHg	DBP/ mmHg		MAP/ mmHg	24 h尿量/ mL
非AKI组		110.73±25.32	68.23±17.85		82.39±19.08	1 355.82±402.37
AKI组		104.11±21.74	64.29±15.48		77.56±16.77	1 226.91±309.84
t		1.406	1.181		1.345	1.811
组别		Scr/ （μmol/L）		WBC/ （×10⁹/L）		PCT/ （μg/L）
非AKI组		88.83±21.72		14.27±3.79		11.00±3.00
AKI组		310.80±96.20		13.65±3.68		28.00±8.00
t		14.993^＊		0.825		13.365^＊
组别		IL-6/ （ng/L）		CysC/ （mg/L）		死亡
非AKI组		91.88±8.12		1.46±0.39		15（11.36）
AKI组		201.02±15.27		3.14±0.94		24（42.86）
t或χ²		42.857^＊		11.118^＊		0.796

组别	n	性别（男/女）	年龄/ 岁	BMI/ （kg/m²）	感染部位^①	合并症^②
非AKI组	44	25/19	56.08±18.25	22.29±2.96	4/30/3/7	4/5/3/32
AKI组	56	43/13	65.14±15.87	22.55±3.10	1/43/8/4	11/8/14/23
χ²或t		4.515^＊	2.652^＊	0.425	5.850	11.272^＊
组别		发病时间/d	机械通气	感染性休克	APACHEⅡ 评分/分	心率/ （次/min）
非AKI组		9.34±2.52	23（52.27）	25（56.82）	18.00±7.03	103.25±21.04
AKI组		5.80±1.60	32（57.14）	42（75.00）	24.63±7.08	108.59±22.40
χ²或t		8.551^＊	0.236	3.684	4.663^＊	1.215
组别		SBP/ mmHg	DBP/ mmHg		MAP/ mmHg	24 h尿量/ mL
非AKI组		110.73±25.32	68.23±17.85		82.39±19.08	1 355.82±402.37
AKI组		104.11±21.74	64.29±15.48		77.56±16.77	1 226.91±309.84
t		1.406	1.181		1.345	1.811
组别		Scr/ （μmol/L）		WBC/ （×10⁹/L）		PCT/ （μg/L）
非AKI组		88.83±21.72		14.27±3.79		11.00±3.00
AKI组		310.80±96.20		13.65±3.68		28.00±8.00
t		14.993^＊		0.825		13.365^＊
组别		IL-6/ （ng/L）		CysC/ （mg/L）		死亡
非AKI组		91.88±8.12		1.46±0.39		15（11.36）
AKI组		201.02±15.27		3.14±0.94		24（42.86）
t或χ²		42.857^＊		11.118^＊		0.796

组别	AUC	95%CI	Cut-off值	敏感度/%	特异度/%	约登指数
PCT	0.706	0.649~0.763	20.00 μg/L	80.36	75.00	0.554
IL-6	0.642	0.591~0.693	150.00 ng/L	69.64	68.18	0.378
CysC	0.752	0.706~0.794	2.00 mg/L	85.71	79.55	0.653
联合	0.859	0.769~0.949	-	91.07	90.91	0.820

组别	AUC	95%CI	Cut-off值	敏感度/%	特异度/%	约登指数
PCT	0.706	0.649~0.763	20.00 μg/L	80.36	75.00	0.554
IL-6	0.642	0.591~0.693	150.00 ng/L	69.64	68.18	0.378
CysC	0.752	0.706~0.794	2.00 mg/L	85.71	79.55	0.653
联合	0.859	0.769~0.949	-	91.07	90.91	0.820

组别		n	性别（男/女）					年龄/ 岁					BMI/ （kg/m²）		感染部位^①					合并症^②
存活组		32	23/9					64.56±15.92					22.51±3.16		1/23/4/4					7/5/6/14
死亡组		24	20/4					65.92±15.77					22.61±3.02		0/20/4/0					4/3/8/9
χ²或t			1.010					0.318					0.119		4.151					1.580
组别	发病时间/d						机械通气		感染性休克					APACHEⅡ 评分/分					心率/ （次/min）
存活组	5.71±1.34						19（59.38）		23（71.88）					22.53±6.12					106.81±21.98
死亡组	5.92±1.95						13（54.17）		19（79.17）					27.42±7.30					110.96±22.72
t或χ²	0.478						0.152		0.389					2.724^＊					0.689
组别						SBP/ mmHg						DBP/ mmHg				MAP/ mmHg
非AKI组						105.31±22.93						66.91±15.09				79.71±16.86
AKI组						102.50±19.92						60.79±15.30				74.69±16.21
t						0.480						1.493				1.121
组别				24 h尿量/ mL							Scr/ （μmol/L）						WBC/ （×10⁹/L）
非AKI组				1 245.82±318.74							324.66±95.43						13.61±3.81
AKI组				1 201.70±297.97							292.38±97.23						13.71±3.51
t				0.527							1.243						0.101
组别					PCT/ （μg/L）					IL-6/ （ng/L）								CysC/ （mg/L）
非AKI组					25.90±6.00					161.42±10.06								2.91±0.87
AKI组					30.80±10.70					253.82±22.22								3.45±1.03
t					2.178^＊					20.887^＊								2.124^＊