可溶性CD73联合SOFA评分对脓毒症相关急性肾损伤患者28 d死亡风险的预测价值

目的探讨血清可溶性CD73(sCD73)联合序贯器官衰竭评分(SOFA)对脓毒症相关急性肾损伤(SA-AKI)患者28d死亡风险的预测价值。方法前瞻性收集184例SA-AKI患者和50例健康志愿者临床资料。根据28 d转归将SA-AKI患者分为存活组(n=142)和死亡组(n=42)。按AKI分期标准分为AKIⅠ期(n=90)、AKIⅡ期(n=50)和AKIⅢ期(n=44)。单因素和多因素Logistic回归分析临床资料,确定SA-AKI患者28 d死亡的独立影响因素。Spearman相关性分析探讨SA-AKI患者血清sCD73水平与SOFA评分的相关性。利用受试者工作特征(ROC)曲线评估血清sCD73水平、SOFA评分及两者联合检测对SA-AKI患者28 d死亡风险的预测价值。结果SA-AKI患者血清sCD73水平明显高于健康志愿者[μg/L:7.42(4.29,11.23)vs.5.37(3.14,7.27),P<0.001]。SA-AKI患者28 d病死率为22.8%(42/184)。死亡组血清sCD73水平明显低于存活组[μg/L:2.76(1.78,7.32)vs.8.07(5.81,11.75),P<0.001],SOFA评分明显高于存活组(分:10.67±3.03 vs.7.53±2.89,P<0.001)。随AKI分期的增加,SA-AKI患者血清sCD73水平依次降低,SOFA评分依次升高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄(OR=1.088,95%CI 1.039~1.139,P<0.001)、SOFA评分(OR=1.341,95%CI 1.127~1.597,P=0.001)、AKIⅡ期(OR=8.719,95%CI 1.665~45.651,P=0.010)、AKIⅢ期(OR=29.920,95%CI 5.009~178.709,P<0.001)、连续性肾脏替代治疗(OR=0.138,95%CI 0.027~0.693,P=0.016)和sCD73(OR=0.910,95%CI 0.833~0.993,P=0.034)是SA-AKI患者28 d死亡的独立影响因素。血清sCD73水平与SOFA评分呈负相关(rs=-0.319,P<0.001)。ROC曲线分析结果显示,血清sCD73水平与SOFA评分联合检测预测SA-AKI患者28 d死亡风险的AUC明显高于两个指标单独预测(0.854 vs.0.766,Z=2.160,P<0.05;0.854 vs.0.785,Z=2.925,P<0.05)。血清sCD73最佳截断值为5.84μg/L时,诊断敏感度为71.43%,特异度为72.54%;SOFA评分最佳截断值为8分时,诊断敏感度为80.96%,特异度为66.90%。两者联合检测的敏感度为83.33%,特异度为78.87%。结论血清sCD73水平降低、SOFA评分升高是SA-AKI患者28 d死亡的独立危险因素,两者联合检测对SA-AKI患者的28 d死亡风险具有良好的预测价值。

Predictive value of soluble CD73 combined with SOFA score for 28-day mortality risk in the patients with sepsis associated acute kidney injury

Objective To investigate the predictive value of serum soluble CD73(sCD73)combined with sequential organ failure assessment(SOFA)score for 28-day mortality risk in the patients with sepsis associated acute kidney injury(SA-AKI).Methods A total of 184 patients with SA-AKI and 50 healthy volunteers were recruited in this prospective cohort study.According to the 28-day prognosis,the patients were divided into the survival group(n=142)and the death group(n=42).According to AKI staging criteria,the patients were divided into AKIⅠstage(n=90),AKIⅡstage(n=50)and AKIⅢstage(n=44).Univariate and multivariate Logistic regression analysis were performed to identify the influencing factors of 28-day mortality in the patients with SA-AKI.The correlations between serum sCD73 level and SOFA score in the patients with SA-AKI were analyzed by Spearman correlation analysis.Receiver operating characteristic curve(ROC)was applied to analyze the predictive value of serum sCD73 level,SOFA score and their combined detection for predicting 28-day mortality risk in the patients with SA-AKI.Results The serum levels of sCD73 in the patients with SA-AKI was higher than that in healthy volunteers[μg/L:7.42(4.29,11.23)vs.5.37(3.14,7.27),P<0.001].The total mortality within 28 days of the patients with SA-AKI was 22.8%(42/184).The serum levels of sCD73 in the death group was significantly lower than that in the survival group[μg/L:2.76(1.78,7.32)vs.8.07(5.81,11.75),P<0.001],SOFA score was significantly higher than that in the survival group(scores:10.67±3.03 vs.7.53±2.89,P<0.001).With the increase of AKI stages,the serum levels of sCD73 in the patients with SA-AKI decreased in turn,and the SOFA score increased in turn,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that age(OR=1.088,95%CI 1.039-1.139,P<0.001),SOFA score(OR=1.341,95%CI 1.127-1.597,P=0.001),AKIⅡstage(OR=8.719,95%CI 1.665-45.651,P=0.010),AKIⅢstage(OR=29.920,95%CI 5.009-178.709,P<0.001),continuous renal replacement therapy(OR=0.138,95%CI 0.027-0.693,P=0.016)and sCD73(OR=0.910,95%CI 0.833-0.993,P=0.034)were the influencing factors for 28-day mortality risk in the patients with SA-AKI.Serum sCD73 level was negatively correlated with SOFA score(rs=-0.319,P<0.001).ROC curve analysis showed that the area under the curve(AUC)of serum sCD73 level combined with SOFA score for predicting 28-day mortality risk in the patients with SA-AKI was significantly larger than that of serum sCD73 level or SOFA score alone(0.854 vs.0.766,Z=2.160,P<0.05;0.854 vs.0.785,Z=2.925,P<0.05).The optimal cut-off value of serum sCD73 level was 5.84μg/L,and the sensitivity and specificity were 71.43%and 72.54%,respectively.The optimal cut-off value of SOFA score was 8 scores,and the sensitivity and specificity were 80.96%and 66.90%,respectively.And the sensitivity and specificity of the combined detection of sCD73 and SOFA score were 83.33%and 78.87%,respectively.Conclusions The decrease of serum sCD73 level and the increase of SOFA score were independently risk factor for 28-day mortality in the patients with SA-AKI,and serum sCD73 level combined with SOFA score had a good predictive value for 28-day mortality risk in the patients with SA-AKI.