Plasma presepsin for mortality prediction in patients with sepsis-associated acute kidney injury requiring continuous kidney replacement therapy.

IF 2.9 3区医学 Q1 UROLOGY & NEPHROLOGY

Kidney Research and Clinical Practice Pub Date : 2024-07-01 Epub Date: 2024-06-11 DOI:10.23876/j.krcp.23.301

Gi-Beop Lee, Ji Won Lee, Se-Hee Yoon, Won Min Hwang, Sung-Ro Yun, Dong Hoon Koh, Yohan Park

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引用次数: 0

Abstract

Background: The reliability of presepsin as a biomarker of sepsis may be reduced in patients with acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT). This study analyzed the utility of plasma presepsin values in predicting mortality in patients with AKI requiring CKRT, particularly those with sepsis-associated AKI.

Methods: This single-center retrospective study included 57 patients who underwent CKRT, with plasma presepsin measurements, from April 2022 to March 2023; 35 had sepsis-associated AKI. The predictive values of plasma presepsin, as well as Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, for 28-day mortality were analyzed using receiver operating characteristic curves. Multivariate Cox regression analysis was performed to identify risk factors for 28-day mortality in the sepsis-associated AKI subgroup.

Results: Overall, plasma presepsin showed a lower area under the curve value (0.636; 95% confidence interval [CI], 0.491-0.781) than the APACHE II (0.663; 95% CI, 0.521-0.804) and SOFA (0.731; 95% CI, 0.599-0.863) scores did. However, in sepsis-associated AKI, the area under the curve increased to 0.799 (95% CI, 0.653-0.946), which was higher than that of the APACHE II (0.638; 95% CI, 0.450-0.826) and SOFA (0.697; 95% CI, 0.519-0.875) scores. In the multivariate Cox regression analysis, a high presepsin level was an independent risk factor for 28-day mortality in sepsis-associated AKI (hazard ratio, 3.437; p = 0.03).

Conclusion: Presepsin is a potential prognostic marker in patients with sepsis-associated AKI requiring CKRT.

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血浆前血蛋白用于预测需要持续肾脏替代治疗的脓毒症相关急性肾损伤患者的死亡率。

背景：在需要持续肾脏替代治疗（CKRT）的急性肾损伤（AKI）患者中，前血蛋白作为脓毒症生物标志物的可靠性可能会降低。本研究分析了血浆前胰蛋白酶值在预测需要进行 CKRT 的急性肾损伤患者，尤其是脓毒症相关急性肾损伤患者的死亡率方面的效用：这项单中心回顾性研究纳入了从 2022 年 4 月至 2023 年 3 月期间接受 CKRT 并测量血浆前血蛋白的 57 例患者，其中 35 例患有败血症相关性 AKI。研究人员利用接收器操作特征曲线分析了血浆前体素以及急性生理学和慢性健康评估 II（APACHE II）和序贯器官衰竭评估（SOFA）评分对 28 天死亡率的预测值。对脓毒症相关 AKI 亚组进行了多变量 Cox 回归分析，以确定 28 天死亡率的风险因素：结果：总体而言，血浆前皮素的曲线下面积值（0.636；95% 置信区间 [CI]，0.491-0.781）低于 APACHE II（0.663；95% CI，0.521-0.804）和 SOFA（0.731；95% CI，0.599-0.863）评分。然而，在脓毒症相关性 AKI 中，曲线下面积增至 0.799（95% CI，0.653-0.946），高于 APACHE II（0.651；95% CI，0.450-0.826）和 SOFA（0.697；95% CI，0.519-0.875）评分。在多变量考克斯回归分析中，高前蛋白水平是脓毒症相关性 AKI 28 天死亡率的独立风险因素（危险比为 3.437；P = 0.03）：前血蛋白是需要进行 CKRT 的脓毒症相关性 AKI 损伤患者的潜在预后标志物。

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来源期刊

Kidney Research and Clinical Practice UROLOGY & NEPHROLOGY-

CiteScore

4.60

自引率

10.00%

发文量

审稿时长

10 weeks

期刊介绍： Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.