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| Predictive value of soluble thrombomodulin in acute renal injury induced by sepsis |
| Guo Jun-chuan, Liu Qi, Xiao Dong |
| Intensive Care Unit, People′s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang 830000, China |
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Abstract Objective Evaluate the value of endothelial injury biomarkers in predicting acute kidney injury (AKI) in patients with sepsis. Methods This study analyzed 114 sepsis patients admitted to our ICU between July 2015 and October 2017. The researchers used kidney-based criteria to improve overall prognostic creatinine in patients with AKI, including those requiring renal replacement therapy. The severity of the illness was measured by the APACHEⅡ score and the SOFA score. Statistically significant parameters in the univariate analysis were included in a Logistic regression model for multivariate analysis to determine independent predictors of AKI. Results The final 114 patients with sepsis met the inclusion and exclusion criteria, of which 63 cases non-AKI group and 51 cases with AKI group. There was no significant difference between the two groups in age, gender, BMI, infection site (P>0.05). There were significant differences in APACHEⅡ score, SOFA score, chronic renal insufficiency, septic shock, disseminated intravascular coagulation, mechanical ventilation, ICU stay, CRRT and 28-day mortality in AKI group compared with non-AKI group (P＜0.05). In the endothelial markers, soluble thrombomodulin (sTM, ng/mL: 11.9±3.3 vs. 7.6±2.1, P＜0.001), E-selectin (ng/mL: 65.7±13.5 vs. 45.5±10.5, P＜0.001) and PAI-1 (ng/mL: 178.6±32.6 vs. 75.5±21.0, P＜0.001), while the level of protein C was significantly lower (%: 45.6±9.6 vs. 56.8±11.3, P＜0.001). In coagulation biomarkers, platelet count, FDP, PT, AT Ⅲ, plasminogen and α2-PI in AKI group were significantly different from those in non-AKI group (P＜0.05). sTM has high specificity (98%) but limited sensitivity (55%) and AUROC of 0.735 (P＜0.001). Multivariate Logistic regression analysis showed that sTM was an independent predictor of AKI (OR: 0.74,95%CI0.35～1.24, P=0.033). Conclusion Endothelial biomarkers change significantly in patients with AKI and sepsis. sTM is an independent predictor of AKI in sepsis that outperforms other coagulation and inflammatory biomarkers and organ function.
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Corresponding Authors:
Xiao Dong, E-mail:xiao1972dong@163.com
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