#3644 CLINICAL VALUE OF SOLUBLE UROKINASE-TYPE PLASMINOGEN ACTIVATOR RECEPTOR IN DIAGNOSIS AND PROGNOSIS OF SEPSIS-ASSOCIATED ACUTE KIDNEY INJURY

Abstract

Abstract Background and Aims Acute kidney injury (AKI) is a common complication of hospitalized adults with increased risk of chronic kidney disease and end-stage kidney disease. Sepsis is the most common reason of AKI in patients admitted in intensive care unit(ICU) with the incidence over 50%. Soluble urokinase-type plasminogen activator receptor (suPAR) is an important immune mediator involved in kidney injury. Numerous studies have shown that the suPAR is associated with a variety of kidney diseases.However, it remains unknown on the diagnosis and prognosis value of suPAR in sepsis-associated acute kidney injury (S-AKI). Hence,this study aimed to explore the diagnostic value for the prediction of S-AKI courses and 28-day death. Method In this prospective study, adult patients with sepsis admitted to the ICU of Henan people's Hospital from December 2020 to February 2022 were enrolled. Plasma suPAR levels at 0, 12,24 and 48 hours after admission to ICU were measured by enzyme-linked immunosorbent assay. We assessed the development of S-AKI as the primary outcome and the occurrence of death within 28 days in patients who had S-AKI as a secondary outcome. The prediction of the suPAR level on S-AKI and death was tested using receiver operating characteristic curve (ROC) analysis, by calculating the area under the curve (AUC), and 95% confidence interval (CI). Results Of the 182 sepsis patients, 66 (36.3%) developed AKI during hospitalization, of whom 31 (46.9%) died. At 12,24 and 48 hours after admission to ICU, the plasma suPAR level was significantly higher in patients with S-AKI than in patients without AKI (P<0.05). (Figue 1) In sepsis patients dead with 28 days after admission in ICU, the plasma suPAR level was significantly higher at 0 and 48 hours after admission in ICU compared to the survival patients(P<0.05). (Figue 1) Diagnostic performance of plasma suPAR level improved over time with the highest area under the receiver operating characteristic curve of 0.701 (95% CI, 0.623∼0.779) 24 hours after study inclusion. Additionally, plasma suPAR levels at 0h have the highest area under the receiver operating characteristic curve of 0.647 (95% CI, 0.512∼0.782) in predicting 28-day death. The best discrimination ability for the S-AKI was achieved for suPAR 24 hours after inclusion by applying a cutoff value of greater than or equal to 6.31 ng/ml (sensitivity 62.1, specificity 71.6). The suPAR at 0h after inclusion performed best in discriminating 28-day death by using a cutoff value of greater than or equal to 4.57 ng/mL (sensitivity 87.1, specificity 51.4). (Table 1) Conclusion Plasma suPAR level can be a potential biomarker for early diagnosis of S-AKI and has a certain clinical value in predicting the short-term death of S-AKI. However, further clinical studies with larger sample size is needed.