关键词: 脓毒症, 急性肾损伤, 细胞黏附分子, 预测价值, 炎性指标, 灵敏度, 特异度

Abstract: Background　Cell adhesion molecules are biomarkers of organ dysfunction caused by acute severe sepsis（such as kidney injury），but it is not clear whether serum cell adhesion molecules have clinical value in the prediction of acute kidney injury（AKI） in sepsis.Objective　To study the predictive value of serum cell adhesion molecules for AKI in sepsis.Methods　From January 2016 to December 2017，84 patients with sepsis from the EICU，Affiliated Hospital of Nantong University were enrolled，and were divided into AKI group and non-AKI group（AKI was identified by the relevant diagnostic criteria）.The clinical data were collected within 24 hours after admission，and the Acute Physiology and Chronic Health Evaluation（APACHE）Ⅱ score，sequential organ failure assessment（SOFA），and Charlson comorbidity index（CCI） were calculated.The inflammatory indices such as C-reactive protein（CRP），procalcitonin（PCT），lactate（LAC） and the levels of serum cell adhesion molecule-1（ICAM-1），vascular cell adhesion molecule-1（VCAM-1），platelet selectin（p-selecin），endothelial selectin（E-selectin） were measured.Pearson correlation analysis was used to analyze the relationships of inflammatory indices，serum cell adhesion molecule with AKI severity.ROC curve analysis was used to evaluate the relationships of inflammatory indices，and serum cell adhesion molecule with AKI prognosis.Results　The incidence of shock，the proportion of receiving mechanical ventilation，mean APACHE Ⅱ score，SOFA score，Scr，LAC，ICAM-1，VCAM-1 and E-selectin in AKI group were higher than those in non-AKI group（P<0.05）.Pearson correlation analysis showed that E-selectin was positively correlated with Scr（r=0.223，P=0.041）.For predicting septic AKI，the area under the ROC curve（AUC） of CRP，PCT，LAC，ICAM-1，VCAM-1 and E-selectin was 0.523〔95%CI（0.421，0.687）〕，0.637〔95%CI（0.435，0.618）〕，0.609〔95%CI（0.529，0.781）〕，0.702〔95%CI（0.619，0.846）〕，0.661〔95%CI（0.503，0.794）〕，0.774〔95%CI（0.623，0.871）〕，respectively，among which the predictive value of E-selectin was the largest，with a predictive value of 117.2 μg/L（79.8% sensitivity and 71.0% specificity）.Conclusion　The mortality of patients with septic AKI is higher than that of patients with sepsis.E-selectin is related to the severity of AKI，which may be an important clinical marker for predicting AKI in sepsis.

Key words: Sepsis, Acute kidney injury, Cell adhesion molecules, Predictive value, Inflammatory markers, Sensitivity, Specificity