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    脓毒症相关急性肾损伤在连续肾替代治疗早期降钙素原的预测价值

    Predictive value of procalcitonin in the early stage of continuous renal replacement therapy of sepsis-associated acute kidney injury

      摘要
    • 摘要:
      目的探讨降钙素原（PCT）在连续肾替代治疗（CRRT）早期的水平趋势对脓毒症相关急性肾损伤（AKI）病人预后的预测价值。
      方法选择诊断为脓毒症相关AKI并且行CRRT的25例病人，根据第28天预后情况分为存活组（n=10）和死亡组（n=15）。检测CRRT后不同时间点（上机前，上机12 h、24 h及下机24 h）血清PCT、白细胞计数（WBC）、C反应蛋白（CRP）水平，计算不同时间点PCT清除率（%），并记录一般临床资料，比较2组间的差异，利用受试者工作曲线（ROC曲线）评估其对预后的预测价值。
      结果2组病人在不同时间点血清PCT、WBC、CRP水平比较差异均无统计学意义（P>0.05），但2组间血清PCT清除率在下机24 h比较差异均有统计学意义（P < 0.01）。上机12 h、上机24 h PCT清除率的ROC曲线下面积分别为0.620、0.693，下机24 h PCT清除率的ROC曲线下面积为0.980（95%CI：0.934~1.000），以21.5%作为cut-off值，敏感度为90.0%，特异度为100.0%。
      结论脓毒症相关AKI病人在CRRT早期时，PCT、CRP、WBC水平及CRRT运行期间的PCT清除率对预后预测价值有限，下机24 h PCT清除率对预后具有较高的预测价值。

       

      Abstract:
      ObjectiveTo evaluate the prognostic value of procalcitonin (PCT) in the early stage of continuous renal replacement therapy (CRRT) of septic-associated acute kidney injury (AKI).
      MethodsTwenty-five sepsis-associated AKI patients treated with CRRT were divided into the survival group (n=10) and death group (n=15) according to 28 days prognosis.At different time points after CRRT treatment, the serum PCT, white blood cell ount (WBC), C reactive protein (CRP) levels in two groups were detected, and the PCT clearance (%) was calculated.The general clinical data in two groups were recorded, and the difference of which was compared between two groups.The receiver operating curve (ROC) was used to evaluate its prognostic value.
      ResultsThere was no statistical significance in the levels of serum PCT, WBC and CRP between two groups at different time points (P>0.05), but the difference of serum PCT clearance between two groups was statistically significant after 24 h of CRRT shutdown (P < 0.01).The area under the ROC curve of the clearance rates of 12 h and 24 h PCT after starting CRRT were 0.620 and 0.693, respectively.The area under the ROC curve of the clearance rate of 24 h PCT after CRRT was 0.980 (95% CI:0.934-1.000).Using 21.5% as the cut-off value, the sensitivity was 90.0%, and the specificity was 100.0%.
      ConclusionsIn the early CRRT stage of sepsis-associated AKI patients, inflammatory indicators (PCT, WBC and CRP) have limited prognostic value.The clearance rate of 24 h PCT after CRRT shutdown has a high prognostic value.

       

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