Objective: To explore the predictive value of serum procalcitonin(PCT), hypersensitive C-reactive protein(hs-CRP), and Th17 cell on the outcome of continuous renal replacement therapy(CRRT) in patients with sepsis associated acute renal injury(SA-AKI). Methods: 211 patients with SA-AKI who visited our hospital from January 2021 to October 2022 were selected and divided into an observation group(n=84) and a control group(n=127) based on the differences in treatment strategies. The control group received routine treatment, while the observation group received CRRT treatment. The levels of biochemical markers(PCT, hs-CRP, Th17 cell) were compared between the two groups before and 72 hours after treatment. Based on the survival status 28 days after the first CRRT treatment, they were divided into death group and survival group. To compare the clinical characteristics of patients with different prognosis in the observation group, the receiver operator characteristic curve(ROC) curve was used to analyze the predictive value of PCT, hs-CRP, and Th17 cell in predicting the prognosis of CRRT treatment in SA-AKI patients. Results: After treatment, the levels of PCT, hs-CRP, and Th17 cell in the observation group were significantly lower than those in the control group(P<0.05). Among 84 cases in the observation group, 56 cases were in the survival group and 28 cases were in the death group. There was a significant difference between the two groups in terms of age, length of stay in ICU, PCT, hs-CRP, Th17 cell, APACHE Ⅱ, SOFA scores(P<0.05). ROC curve results showed that the AUC of PCT, hs-CRP, Th17 cell jointly predicting poor prognosis of SA-AKI patients after CRRT treatment was 0.864(95%CI:0.775-0.923) higher than that of other single biomarkers(P<0.05). The sensitivity and specificity were 85.69% and 79.41%, respectively. Conclusion: PCT, hs-CRP, and Th17 cell are valuable in predicting the outcome of CRRT treatment in SA-AKI patients. |
[1] 江伟,杜斌.中国脓毒症流行病学现状[J].医学研究生学报,2019,32(1):5-8.
[2] 明颖,闫妹姝,刘秋霞,等.血清PCT、IL-6与CRP对严重创伤致脓毒症预后的影响[J].现代医学,2019,47(5):543-547.
[3] 张宇慧,杨莉.脓毒症相关急性肾损伤[J].临床内科杂志,2022,39(6):372-376.
[4] MANRIQUE-CABALLERO C L,DEL RIO-PERTUZ G,GOMEZ H.Sepsis-associated acute kidney injury[J].Crit Care Clin,2021,37(2):279-301.
[5] 陈一欢,蔡成,裘刚,等.连续性肾脏替代治疗救治新生儿脓毒症相关性急性肾损伤临床分析[J].中华新生儿科杂志(中英文),2019,34(6):443-447.
[6] ROMAGNOLI S,RICCI Z,RONCO C.CRRT for sepsis-induced acute kidney injury[J].Curr Opin Crit Care,2018,24(6):483-492.
[7] 蒋怡佳,席修明,郑爔,等.ICU中新发急性肾损伤首次连续肾脏替代治疗患者死亡的危险因素分析及风险预测模型构建[J].中国急救医学,2022,42(5):387-392.
[8] 刘莉,刘名鑫,牛世慧,等.脓毒症并发急性肾损伤患者肾功能衰竭的影响因素[J].中华医院感染学杂志,2021,31(20):3078-3081.
[9] 刘云涛,李俊,王大伟,等.脓毒症并发PICS的早期临床特征及相关影响因素分析[J].广州中医药大学学报,2021,38(3):441-448.
[10] 高爽,张放,马帅,等.脓毒症急性肾损伤与免疫功能的相关性研究[J].中华急诊医学杂志,2015,24(4):416-421.
[11] 中国医疗保健国际交流促进会急诊医学分会,中华医学会急诊医学分会,中国医师协会急诊医师分会,等.中国脓毒症早期预防与阻断急诊专家共识[J].中华急诊医学杂志,2020,29(7):885-895.
[12] 曾小娜,尹连红,许丽娜.脓毒症性急性肾损伤发病机制[J].生理科学进展,2020,51(2):122-126.
[13] LELUBRE C,VINCENT J L.Mechanisms and treatment of organ failure in sepsis[J].Nat Rev Nephrol,2018,14(7):417-427.
[14] 黄梦婷,陈铮锐,王熠.持续性肾脏替代治疗对脓毒症合并急性肾损伤患者的疗效研究[J].中国中西医结合肾病杂志,2021,22(11):993-995.
[15] 陈珊珊,岳英丽,刘东海,等.连续性肾脏替代治疗脓毒症急性肾损伤的疗效及对TLRs通路的影响[J].临床和实验医学杂志,2021,20(17):1838-1841.
[16] 张世慧,张燕.影响脓毒症相关急性肾损伤患者接受连续性肾脏替代治疗的相关因素分析[J].传染病信息,2019,32(4):341-343,345.
[17] 盛松,张艳虹,马杭琨,等.脓毒症合并急性肾损伤并接受连续肾脏替代治疗患者28 d死亡预测模型构建与验证[J].创伤与急危重病医学,2021,9(3):200-205,210.
[18] 王雪婷,高雪花,关银,等.血降钙素原对脓毒症相关急性肾损伤的诊断价值[J].中国急救医学,2018,38(1):80-83.
[19] 崔凯,郭春保,姜艳艳,等.清热解毒逐瘀方联合连续性肾脏替代疗法治疗脓毒症并发急性肾损伤的临床观察[J].中国中医急症,2022,31(2):300-303.
[20] ZHANG Y,SHAO D R,HE Z P,et al.Efficacy of continuous renal replacement on acute renal injury developed in severe sepsis[J].Biol Regul Homeost Agents,2019,33(2):525-530.
[21] 赵云峰,徐志华,顾维立.连续性血液净化治疗脓毒症合并急性肾损伤患者效果及对免疫和炎症因子影响[J].中国急救复苏与灾害医学杂志,2021,16(8):895-898.
[22] 刘湘园,刘晅,周丽.外周血中Th22和Th17细胞在脓毒症并急性肾损伤患者中变化及意义[J].中国急救复苏与灾害医学杂志,2021,16(10):1138-1141.
[23] 代仔怡,闫新明,武卫东,等.肝素结合蛋白联合降钙素原对脓毒症相关急性肾损伤死亡风险的预测价值[J].中华老年多器官疾病杂志,2022,21(9):660-664.
[24] 梁文生,吴伟,王敏.CVVH联合HA330血液灌流对创伤脓毒症急性肾损伤患者血清HMGB1、hs-CRP、PCT水平及28天死亡的影响[J].中国血液净化,2022,21(5):326-330.
[25] ZHOU X,YAO J,LIN J,et al.Th17/regulatory T-cell imbalance and acute kidney injury in patients with sepsis[J].Clin Med,2022,11(14):4027.
[26] SHENG S,ZHANG Y H,MA H K,et al.Albumin levels predict mortality in sepsis patients with acute kidney injury undergoing continuous renal replacement therapy:a secondary analysis based on a retrospective cohort study[J].BMC Nephrol,2022,23(1):52. |
