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尿渗透压对脓毒症急性肾损伤的早期预测价值

The early predictive value of urine osmolarity in sepsis associated acute kidney injury

    摘要
  • 摘要:
    目的 探讨尿渗透压对脓毒症急性肾损伤（acute kidney injury, AKI）的预测价值。
    方法 前瞻性纳入2021年1月至2022年12月复旦大学附属中山医院重症医学科收治的脓毒症患者152例，收集患者的临床数据和实验室检查资料，根据是否合并AKI分为AKI组（n＝89）和non-AKI组（n＝63）。在脓毒症起病24 h内留取尿液并测量尿渗透压，以评估患者肾脏髓质灌注水平。采用受试者工作特征（receiver operating characteristic, ROC）曲线分析尿渗透压预测脓毒症AKI的效能，并与传统指标（基线肌酐、尿比重）的预测效能进行比较。
    结果 AKI组尿渗透压低于non-AKI组352(317.56, 383.96) mOsm/kg vs 487(468.79, 559.71) mOsm/kg, P＜0.001。ROC曲线结果显示，尿渗透压预测AKI的AUC为0.820，灵敏度为71.9%、特异度为66.0%，预测效能高于基线肌酐（AUC＝0.706, 灵敏度50.0%、特异度69.7%；P＝0.037）和尿比重（AUC＝0.606, 灵敏度57.4%、特异度60.3%；P＜0.001）。
    结论 尿渗透压有助于早期预测脓毒症AKI的发生。

     

    Abstract:
    Objective To explore the predictive value of urinary osmolality in sepsis associated acute kidney injury (AKI).
    Methods A total of 152 patients with sepsis in the Department of Critical Care Medicine, Zhongshan Hospital, Fudan University from January 2021 to December 2022 were prospectively included, and clinical data and laboratory data were collected. All the patients were divided into AKI group (n＝89) and non-AKI group (n＝63). Urine was collected within 24 hours after sepsis onset, and urine osmolality was measured to assess the level of renal medullary perfusion. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of urine osmolality in predicting sepsis associated AKI, which was compared with that of the traditional indexes (baseline creatinine and urine specific gravity).
    Results Urinary osmolality in AKI group was lower than that in non-AKI group (352317.56, 383.96 mOsm/kg vs 487468.79, 559.71 mOsm/kg, P < 0.001). ROC curve analysis showed that the predictive value of urine osmolality (AUC＝0.820, sensitivity 71.9%, specificity 66.0%) was higher than that of the baseline creatinine (AUC 0.706, sensitivity 50.0%, specificity 69.7%; P＝0.037) and urine specific gravity (AUC＝0.606, sensitivity 57.4%, specificity 60.3%; P < 0.001).
    Conclusion The evaluation of renal perfusion by urine osmolality can effectively predict the occurrence of sepsis associated AKI.

     

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