Prognostic value of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin on early continuous renal replacement therapy in sepsis patients with acute kidney injury

Abstract

Objective To evaluate the prognostic value of kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) on early continuous renal replacement therapy (CRRT) in sepsis patients with acute kidney injury (AKI). Methods A total of 159 sepsis patients with AKI in the People's Hospital in Wenzhou from July 2012 to November 2015 were divided into the non-CRRT group (92 cases) and CRRT group (67 cases). Within 24 hours after the diagnosis, the urine samples were collected and the urinary KIM-1 and NGAL levels were measured by enzyme-linked immunosorbent assay. At the same time, the general data of the two groups were compared and the influence factors related to sepsis patients with AKI undergoing early CRRT were analyzed by Logistic regression. The receiver operating characteristic (ROC) was performed to evaluate the early predictive value of urinary KIM-1 and NGAL in septic AKI patients with CRRT. Results The age [(65 ± 18) vs.(77 ± 11) years, t=26.380, P 48 h [32/92 vs. 35/67, χ2=5.239, P=0.024], acute physiology and chronic health evaluation (APACHE) Ⅱscores [16 ± 6 vs. 22 ± 5, t=40.671, P 18, KIM-1 >21.0 ng·L-1·Cr-1 and NGAL >6.5 ng·L-1·Cr-1 were related factors in sepsis patients with AKI undergoing CRRT. Meanwhile, the area under curve (AUC) in ROC of KIM-1, NGAL and combination of the two for early CRRT were 0.783 (95%CI: 0.702-0.864, P<0.05), 0.819 (95%CI: 0.753-0.886, P<0.05) and 0.809 (95%CI: 0.730-0.882, P<0.05), respectively. The Youden index of KIM-1 and NGAL were 0.465, 0.502, and after the combination, the Youden index was up to 0.603. Conclusions Urinary NGAL and KIM-1 have a certain predictive value on early CRRT in sepsis patients with AKI. If both indices were joint detection, the accuracy of prediction will be improved. Key words: Sepsis; Acute kidney injury; Kidney injury molecule-1; Neutrophil gelatinase-associated lipocalin; Continuous renal replacement therapy