Value of vascular endothelial growth factor to the prediction of in-hospital mortality of patients with sepsis induced acute kidney injury
Objective To observe the changes of vascular endothelial function indicators in patients with sepsis induced acute kidney injury(AKI),and to explore their values to the prediction of in-hospital mortality.Methods The clinical data of 122 patients with sepsis induced AKI in the Sixth Affiliated Hospital of Xinjiang Medical University from January 2020 to June 2022 were retrospectively analyzed.They were divided into death group(n=78)and survival group(n=44)according to the in-hospital 30-d survival status.The age,gender ratio,infection site,body mass index,comorbidities(hypertension,diabetes,coronary heart disease),admission laboratory examination results[white blood cell count,activated partial thromboplastin time,serum creatinine,C-reactive protein,procalcitonin,tumor necrosis factor-α,interleukin-6,vascular endothelial growth factor(VEGF),nitric oxide,endothelin-1,intercellular adhesion molecule-1],mean arterial pressure,oxygenation index,acute physiology chronic health evaluation Ⅱ(APACHE Ⅱ)score,multiple organ dysfunction score(MODS),and incidences of in-hospital hemodialysis and shock were compared between two groups.Lasso regression method was used to screen the influencing factors of 30-d mortality of patients with sepsis induced AKI.ROC curves were plotted to evaluate the efficiencies of MODS,shock and serum VEGF alone and in combination on predicting 30-d mortality.The decision curve was used to analyze the values of MODS,shock and serum VEGF alone and in combination to the prediction of 30-d mortality.Results(1)The mean arterial pressure,oxygenation index and serum VEGF level were lower in death group[(81.7±7.4)mmHg,(275.6±45.3)mmHg,(34.2± 6.4)ng/L]than those in survival group[(92.3±7.8)mmHg,(312.3±51.4)mmHg,(76.9±9.2)ng/L](P＜0.05),the APACHE Ⅱ score,MODS,serum creatinine level and incidence of shock were higher in death group[40.5±8.3,19.2±4.6,(145.3±32.6)mmol/L,76.9％]than those in survival group[31.9±8.2,10.3±2.5,(123.2±24.1)mmol/L,29.5％](P＜0.05),and there were no significant differences in the age,gender ratio,infection site,body mass index,comorbidities,white blood cell count,activated partial thromboplastin time,C-reactive protein,procalcitonin,endothelin-1,nitric oxide,tumor necrosis factor-α,interleukin-6 and intercellular adhesion molecule-1 between two groups(P＞0.05).(2)When the optimal λ value in lasso regression analysis was-3.014,the MODS,shock and VEGF were the three most generalized characteristic variables,and 10-fold cross-validation was done.The lasso regression coefficients were 7.836,2.434 and-5.523,respectively.(3)When the optimal cut-off values of MODS score and VEGF level were 14.5 and 45.6 ng/L,the AUCs for predicting 30-d mortality of patients with sepsis induced AKI were 0.832(95％CI:0.758-0.897,P＜0.001)and 0.783(95％CI:0.711-0.886,P＜0.001).The AUC of shock for predicting 30-d mortality was 0.809(95％CI:0.772-0.842,P＜0.001).The AUC of them three in combination was 0.967(95％CI:0.924-0.997,P＜0.001).The decision curve analysis results showed that the net profit of combined application of them three was higher than that of the single one.Conclusion MODS＞14.5,VEGF＜45.6 ng/L and shock indicate a high risk of in-hospital 30-d mortality in patients with sepsis induced AKI,and the combination of MODS,VEGF and shock has a high predictive value.
sepsisacute kidney injuryvascular endothelial growth factorvascular endothelial function
NETL
NSTL
万方数据
维普
