Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.3934
Peer-review started: September 6, 2019
First decision: October 24, 2019
Revised: October 30, 2019
Accepted: November 20, 2019
Article in press: November 20, 2019
Published online: December 6, 2019
Patients with sepsis are more likely to develop acute kidney injury (AKI), which can lead to worse prognosis. Early diagnosis or prediction of AKI of patients with sepsis can greatly improve the prognosis. Currently, serum creatinine (Scr) and urine volume are commonly used diagnostic indicators of AKI, but they are insufficient, making it difficult to detect the occurrence of AKI in time and accurately. For that reason, finding a new way to detect the risk factors and intervene in an early time is the focus of the diagnosis and treatment of septic AKI.
Contrast-enhanced ultrasound (CEUS) can monitor microcirculatory blood perfusion. It has been widely used in many kidney-related diseases because of its simple operation and low nephrotoxicity. In animal experiences, CEUS has been proven to detect changes in renal cortical microcirculation in early ischemia/reperfusion injury, suggesting the possibility of applying it in AKI diagnosis. However, its role in AKI assessment and diagnosis has not been clinically confirmed.
In this study, we analyzed the diagnostic value of general data, biochemical indicators, and CEUS indicators in septic AKI. The aim of this study is to realize early diagnosis and intervention in the development of septic AKI, thereby improving patient prognosis.
Ninety patients who developed sepsis during hospitalization were recruited as subjects. The relevant basic data, clinical indicators, and CEUS results of each patient were measured and recorded. The patients were divided into the AKI group and non-AKI group according to the results of renal function diagnosis after 48 h. The renal function of non-AKI group was reassessed on the 7th day, and the patients in this group were then further divided into AKI subgroup and non-AKI subgroup. The differences of the indicators in different groups were compared, and the diagnostic value of each indicator and their combination for septic AKI were analyzed.
The systemic inflammatory response score (SIRS) , blood lactic acid (Lac) , Scr, blood urea nitrogen (BUN), and rise time (RT) in the AKI group were higher than those in the non-AKI group. Peak intensity (PI) and wash in slope (WIS) were lower than those in the non-AKI group. The differences were statistically significant (P < 0.05). PI and WIS in the AKI subgroup were lower than those in the non-AKI subgroup, and the differences were statistically significant (P < 0.05). The area under curve (AUC) of Scr for the diagnosis of septic AKI was 0.825 with a sensitivity of 56.76% and a specificity of 100%. The AUCs of WIS and PI (0.928 and 0.912) were higher than those of Scr. Their sensitivities were 100%, but the specificities were 71.70% and 75.47%, respectively. The AUC of the combination of three indicators for the diagnosis of septic AKI was 0.943, which was significantly higher than the AUC diagnosed by each single indicator. The sensitivity was 94.59%, and the specificity was 81.13%.
SIRS, Lac, BUN, Scr, PI, WIS, and RT are valuable in diagnosing septic AKI. The diagnostic accuracy of Scr, PI, and WIS was higher than the others, and the combination of the three indicators can improve the accuracy in diagnosing septic AKI.
In order to avoid the interference caused by the differences of individual and environmental factors in different patients, the further study plans to use the combined diagnosis data in more clinical septic AKI patients and adjust the combined diagnosis according to the results in order to find a truly accurate diagnostic method that is truly suitable for clinical use.