Correlation of serum uric acid level with microinflammatory status and prediction of renal injury in patients with sepsis admitted to intensive care unit
Objective:To explore the correlation between uric acid(UA)level and microinflammatory status in patients with sepsis admitted to intensive care unit(ICU)and its predictive value for acute kidney injury(AKI).Methods:Sepsis patients(n=210)admitted to the ICU of our hospital from August 2021 to November 2023 were selected as the research subjects.According to AKI diagnostic criteria,they were divided into AKI group(n=134)and non AKI group(n=76).Clinical data of two groups of patients were compared and analyzed,including age,gender,and blood biochemical indicators upon admission to the ICU.After adjusting for confounding factors,multivariable linear regression(MLR)model was used to analyze the correlation between UA and hs-CRP and IL-6.The risk factors were analyzed using multi-factor logistic regression model and the predictive model was con-structed.The goodness of fit(Hosmer-Lemeshow)test was used to predict the model.The predictive performance of the model was evaluated using the receiver operating characteristic(ROC)curve.The interactions were analyzed using an unconditional logistic regression model and a computational table developed by Andersson et al.The re-stricted cubic splines(RCS)model was used to evaluate the relationship between UA and AKI occurrence OR val-ues.Results:hs-CRP,IL-6,and UA were all positively correlated(P＜0.05),and after adjusting for confounding factors(Model 2),there was still a significant correlation(P＜0.05).Compared with the non-AKI group,the proportion of patients in the AKI group who received vasoactive drugs,mechanical ventilation,renal replacement therapy,septic shock,in-hospital mortality,and ICU hospitalization time were higher(P＜0.05),and the total hospitalization time was shorter(P＜0.05).In multivariate logistic regression analysis,if UA,hs-CRP,and IL-6 were included,UA,APACHE Ⅱ score,PCT,BUN,potassium ions,hs-CRP and IL-6 were all independent in-fluencing factors for the occurrence of AKI(P＜0.05).ROC curve analysis results showed that the AUC of Model 1(excluding UA,hs-CRP,and IL-6)and Model 2(including UA,hs-CRP,and IL-6)predicting AKI was of 0.828(95％CI:0.771-0.890)and 0.854(95％CI:0.782-0.913),respectively.The results of the Hosmer-Lemeshow test showed that the goodness of fit of prediction model 2 was ideal(P=0.596).The results of interac-tion analysis showed that hs-CRP(＞12.30 mg/L),IL-6(＞13.78 pg/mL),and UA(＞435.43 μmol/L)all had additive interaction,and the risk of severe AKI was higher when the two factors co-existed(OR values were 3.148 and 4.278,respectively).RCS model analysis results showed non-linear relationship between UA and AKI risk(non-linear test P＜0.001).Conclusion:Both hs-CRP and IL-6 are positively correlated with UA,and there is additive interaction between the two pairs for severe AKI.UA was independent influencing factor for the occurrence of AKI,and the two exhibited a non-linear dose-response relationship,when UA＞249.5 μmol/L,the risk of AKI increased significantly with the increase of UA levels.
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维普
