期刊
CLINICA CHIMICA ACTA
卷 523, 期 -, 页码 38-44出版社
ELSEVIER
DOI: 10.1016/j.cca.2021.08.029
关键词
Sepsis; Acute kidney injury; Hepcidin; Neutrophil gelatinase-associated lipocalin
资金
- Training Program for Subject Leaders of Shanghai Pudong New District Municipal Health Bureau [PWRd2016-08]
- Shanghai Pudong New Area Science and Technology Development Fund [PKJ2019-Y26]
This study aimed to assess the early predictive values of hepcidin, NGAL, and their combination for secondary AKI in patients with sepsis. Results indicated that higher serum hepcidin and urine NGAL levels at admission were independent predictors of AKI development in critically septic patients. Serum hepcidin and urine NGAL were comparable predictive indicators of AKI occurrence, with their combination showing improved accuracy in prediction.
Background and aims: The early prediction of the development of acute kidney injury (AKI) in critically ill patients with sepsis would facilitate early effective intervention. Recently, interest has focused on the biomarkers for AKI-linked iron metabolism. This study aimed to assess the early predictive values of hepcidin, neutrophil gelatinase-associated lipocalin (NGAL), and their combination for secondary AKI in patients with sepsis. Materials and methods: A prospective cohort study was performed in septic patients. Serum and urine hepcidin, and urine NGAL were analyzed at admission. The primary outcome measure was occurrence of sepsis-induced AKI based on 2011 Kidney Disease: Improving Global Outcomes (KDIGO) criteria during the first week of ICU stay. Results: Of the 90 patients analyzed finally in the study, 44 (48.9%) patients developed AKI. Patients with AKI occurrence were more likely than those without AKI to have higher serum hepcidin and urine NGAL levels at admission (P < 0.01). Higher concentrations of these biomarkers were each independent predictor of the development of AKI in critically septic patients within the first week of their ICU stay. Serum hepcidin and urine NGAL (AUROC 0.787, 95% CI 0.688 to 0.8660 and AUROC 0.729, 95% CI 0.625 to 0.818, respectively) were comparable predictive indicators of AKI occurrence (P = 0.43 for DeLong's test). Combining both biomarkers increased the AUROC to 0.828(95% CI 0.733 to 0.899), and this performance was statistically significantly better than urine NGAL alone (P = 0.03 for DeLong's test). Conclusion: Serum hepcidin measured at admission predicts the development of AKI similarly to urine NGAL. However, serum hepcidin adds significant accuracy to this prediction in combination with urine NGAL alone and has a good predictive value in patients with sepsis. Larger studies are needed to validate and explain these findings.
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