血小板-单核细胞聚集物水平、早期血钠浓度变异度对脓毒症合并急性肾损伤患者预后的预测价值

Predictive value of platelet-monocyte aggregate levels and early variability in serum sodium concentration for prognosis in patients with sepsis-associated acute kidney injury

摘要:

目的 探讨血小板-单核细胞聚集物（PMA）水平、早期血钠浓度变异度对脓毒症合并急性肾损伤（AKI）患者预后的预测价值。方法 选取2022年1月—2025年5月江苏大学附属人民医院重症医学科收治的154例脓毒症合并AKI患者作为研究对象，依据28 d生存结局，分为存活组（92例）和死亡组（62例）。收集患者临床资料，检测患者入院时PMA水平、早期血钠浓度变异度。比较两组PMA水平、血钠浓度变异度，通过多因素一般Logistic回归模型分析影响脓毒症合并AKI患者预后的危险因素，并绘制受试者工作特征（ROC）曲线评估其预测效能。结果 死亡组APACHE Ⅱ评分、SOFA评分、血清肌酐、胱抑素C、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）水平均高于存活组（P <0.05）。存活组PMA水平低于死亡组（P <0.05），早期血钠浓度变异度低于死亡组（P <0.05）。多因素一般Logistic回归分析结果显示：APACHE Ⅱ评分高［O^R=1.048（95% CI：1.003，1.095）］、SOFA评分高［O^R=1.128（95% CI：1.024，1.243）］、KIM-1水平高［O^R=1.191（95% CI：1.069，1.327）］、PMA水平高［O^R=1.033（95% CI：1.006，1.059）］及早期血钠浓度变异度大［O^R=1.253（95% CI：1.010，1.554）］均为脓毒症合并AKI患者28 d内死亡的危险因素（P <0.05）。ROC曲线结果表明，PMA、早期血钠浓度变异度联合预测的曲线下面积为0.983（95% CI：0.964，1.000），敏感性为95.2%（95% CI：0.892，0.990），特异性为95.7%（95% CI：0.892，0.988）。结论 APACHE Ⅱ评分、SOFA评分高、KIM-1水平高、PMA水平高、早期血钠浓度变异度大均为脓毒症合并AKI患者28 d内死亡的危险因素。PMA、早期血钠浓度变异度联合检测对脓毒症合并AKI患者预后的预测价值更高。

Abstract:

Objective To investigate the predictive value of platelet-monocyte aggregate (PMA) levels and early variability in serum sodium concentration for prognosis in patients with sepsis-associated acute kidney injury (AKI).Methods One hundred and fifty-four patients with sepsis-associated AKI admitted to the Department of Critical Care Medicine, Jiangsu University Affiliated People's Hospital between January 2022 and May 2025 were enrolled. Based on 28-day survival outcomes, patients were divided into a survivor group (n = 92) and a non-survivor group (n = 62). Clinical data were collected, and baseline PMA levels and early variability in serum sodium concentration were measured. Comparisons were made between groups for PMA levels and early variability in serum sodium concentration. Multivariable logistic regression analysis identified prognostic risk factors for sepsis-associated AKI. Receiver operating characteristic (ROC) curves assessed the predictive efficacy of PMA levels, early variability in serum sodium concentration, and their combination for prognosis.Results The non-survivor group exhibited higher APACHE Ⅱ scores, SOFA scores, and levels of serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) than the survivor group (P < 0.05). The survivor group demonstrated lower PMA levels and reduced early variability in serum sodium concentration compared with the non-survivor group (P < 0.05). Multivariable logistic regression analysis indicated that high APACHE Ⅱ scores [O^R = 1.048 (95% CI: 1.003, 1.095) ], high SOFA scores [O^R = 1.128 (95% CI: 1.024, 1.243) ], elevated KIM-1 levels [O^R = 1.191 (95% CI: 1.069, 1.327) ], elevated PMA levels [O^R = 1.033 (95% CI: 1.006, 1.059) ] and high early variability in serum sodium concentration [O^R = 1.253 (95% CI: 1.010, 1.554) ] were all risk factors for death within 28 days in patients with sepsis-associated AKI (P < 0.05). The ROC curve analysis revealed that the combination of PMA levels and early variability in serum sodium concentration for predicting the prognosis yielded an area under the curve of 0.983 (95% CI: 0.964, 1.000), with a sensitivity of 95.2% (95% CI: 0.892, 0.990) and specificity of 95.7% (95% CI: 0.892, 0.988).Conclusion APACHE Ⅱ scores, SOFA scores, KIM-1 levels, PMA levels, and early variability in serum sodium concentration are all risk factors for 28-day mortality in patients with sepsis-associated AKI. The combined assessment of PMA levels and early variability in serum sodium concentration demonstrates superior predictive value for the prognosis of patients with sepsis-associated AKI.