NGAL对脓毒症/脓毒性休克患者预后的预测作用（已撤稿）

目的探究中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对脓毒症和脓毒性休克患者预后的预测作用。 方法采用回顾性病例对照研究分析上海交通大学医学院附属瑞金医院急诊科2017年1月31日至2019年1月31日收治且明确诊断为脓毒症/脓毒性休克的84例患者，其中男性53例，女性31例；年龄18～80岁，平均(56.5±17.8)岁。根据患者的预后分为生生存组(n＝62)和死亡组(n＝22)。在患者入院第1天、第3天和第7天检测血浆NGAL水平，比较两组患者临床资料、实验室检查指标水平的差异，筛选出差异有统计学意义的观察指标对比，并采用pearson相关性分析比较NGAL与其他预后指标的相关性。再通过受试者工作特征曲线(ROC)曲线判断NGAL对脓毒症/脓毒性休克患者发生院内死亡和是否需行连续肾脏替代疗法(CRRT)治疗的预测价值。 结果死亡组患者NGAL浓度在第1天[(2 188.4±2 280.8)ng/mL比(538.2±777.4)ng/mL]、第3天[(2 045.5±2 388.8)ng/mL比(553.8±836.4)ng/mL]和第7天[(1 512.4±1 840.9)ng/mL比(192.3±410.2)ng/mL]均明显高于生存组患者，差异均有统计学意义(P<0.05)。NGAL水平与序贯器官衰竭评分(Sequential Organ Failure Assessment, SOFA)(r＝0.4601)、急性生理与慢性健康评分(APACHE Ⅱ)(r＝0.37)、乳酸(r＝0.41)和肌酐(r＝0.48)都呈正相关性(P均<0.05)。第7天时NGAL水平对预后的预测价值[曲线下面积(AUROC)＝0.85，95% CI：0.70～0.99]高于第1天(AUROC＝0.71，95%CI：0.55～0.88)和第3天(AUROC＝0.72，95%CI：0.55～0.88)。第3天时肌酐和NGAL对是否需行CRRT的预测价值优于第1天和第7天。入院第3天时NGAL浓度(AUROC＝0.80，95%CI：0.64～0.97)与肌酐水平(AUROC＝0.83，95%CI：0.68～0.97)相比，前者对患者是否需行CRRT的预测作用具有更好的特异性，但敏感度相对较低。 结论对于脓毒症/脓毒性休克患者第7天时NGAL水平对预后具有很高的预测价值。与肌酐相比，NGAL对预测患者是否需行CRRT具有更高的特异性。

Predictive effect of neutrophil gelatinase-associated apolipoprotein (NGAL) on prognosis in patients with sepsis/septic shock

ObjectiveTo investigate the predictive effect of neutrophil gelatinase-associated apolipoprotein (NGAL) on prognosis in patients with sepsis and septic shock. MethodsIn this study, 84 patients who were admitted to the emergency department of Ruijin Hospital from January 31, 2017 to January 31, 2019 and were clearly diagnosed with sepsis/septic shock were selected as the research subjects to conduct retrospective case analysis, including 53 males , 31 females, aged 18 to 80 years, with average age (56.5ubjects to conduct retrospective case analysis, including 53 males , 31 femaleere divided into the survival group (n=62) and the death group (n=22). The plasma NGAL levels were measured on the first day, the third day, and the seventh day of the patient’s admission, and the clinical results of the two groups were compared. Differences in data and laboratory examination index levels were screened out for comparison of observation indexes with statistical significance, and Pearson correlation analysis was used to compare the correlation between NGAL and other prognostic indexes. The receiver operating characteristic curve (ROC) curve was then used to determine the predictive value of NGAL for the occurrence of in-hospital death in patients with sepsis/septic shock and whether continuous renal replacement therapy (CRRT) was required. ResultsThe NGAL concentration of patients in the death group was [(2 188.4±2 280.8) ng/mL vs.(538.2±777.4)ng/mL] on day 1 and [(2 045.5±2 388.8)ng/mL vs.(553.8±836.4)ng/mL] and the 7th day [(1 512.4±1 840.9)ng/mL vs.(192.3±410.2)ng/mL] were significantly higher than those in the survival group, and the differences were statistically significant (P<0.05). The patientr than those in thsequential organ failure assessment (SOFA) (r=0.4601), acute physiology and chronic health evaluation (APACHE Ⅱ) (r=0.37), lactic acid (r=0.41) and creatinine (r=0.48) had a strong positive correlation (P<0.05). The prognostic value of NGAL level on day 7 [area under the curve (AUROC)=0.85, 95% CI: 0.70-0.99] was higher than that on day 1 (AUROC=0.71, 95% CI: 0.55-0.88) and the third day (AUROC=0.72, 95%CI: 0.55-0.88). The predictive value of creatinine and NGAL on day 3 for CRRT was better than that on day 1 and day 7. Compared with the creatinine level (AUROC=0.83, 95%CI: 0.68-0.97) of NGAL concentration (AUROC=0.80, 95%CI: 0.64-0.97) on the third day of admission, the former had a predictive effect on whether patients need CRRT with better specificity, but relatively low sensitivity. ConclusionThe NGAL concentration on day 7 has a high predictive value for prognosis. Compared with creatinine, NGAL is more specific in predicting whether patients need CRRT.