THE VALUE OF NGAL, CYS-C, AND STREM-1 IN THE DIAGNOSIS AND PREDICTION OF ACUTE RENAL INJURY IN SEPSIS

Fulan Cen^#, Tengfei Zhu^#, Zhenghao Lin^*

Department of Critical Medicine, Shenzhen Third People's Hospital (Second Affiliated Hospital of South University of Science and Technology), Shenzhen 518114, PR China

Objective: To explore the value of plasma and urine neutrophil gelatinase-related lipid delivery protein (NGAL), Cystatin C (Cys-C), and soluble myeloid cell expression stimulating factor-1 (sTREM-1) in the diagnosis and prediction of acute renal injury (AKI) in sepsis. 

Methods: A group of 130 patients with sepsis who were admitted to ICU of our hospital from October 2018 to October 2019 was divided into an AKI group (n = 56) and a non-AKI group (n = 74) according to whether they had an AKI complication. Both 5 ml of fasting venous blood and 8 ml of early morning urine were collected from all subjects. The NGAL level in urine was detected by an ORMAN-2 scatter turbidimetric analyzer. An NGAL detection kit and latex immunoturbidimetry were used to detect the levels of Cys-C in urine and serum. A double clip enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of sTREM-1 in the serum and urine of all patients. Multivariate logistic regression was used to analyze the influencing factors of AKI in sepsis patients, and an ROC curve was used to analyze NGAL, Cys-C, and sTREM-1 in plasma and urine for the diagnosis and prediction of AKI in sepsis. 

Results: The serum levels of NGAL, Cys-C, and sTREM-1 in the serum of the AKI group were significantly higher than those in the non-AKI group (P<0.01). The levels of NGAL, Cys-C, and sTREM-1 in the urine of the AKI group were significantly higher than those of the non-AKI group (P<0.01 or P<0.05). Multiple logistic regression analysis showed that NGAL, Cys-C, and sTREM-1 in urine and NGAL, Cys-C, and sTREM-1 in serum were risk factors for AKI in sepsis patients. For the patients in the non-AKI group, the area under the curve (AUC) of NGAL in serum and urine was 0.815 and 0.856, respectively, the AUC of Cys-C in serum and urine was 0.735 and 0.775, respectively, and the AUC of sTREM-1 in serum and urine was 0.705 and 0.725, respectively. For the AKI group, the AUC of NGAL in serum and urine was 0.832 and 0.849, respectively, the AUC of Cys-C in serum and urine was 0.748 and 0.741, respectively, and the AUC of sTREM-1 in serum and urine was 0.725 and 0.728, respectively. 

Conclusion: The levels of NGAL, Cys-C, and sTREM-1 in the plasma and urine of patients with sepsis and AKI are higher than those of patients with sepsis only, and NGAL, Cys-C, and sTREM-1 in plasma and urine have a certain value in diagnosing and predicting AKI in sepsis and AKI, among which the plasma and urine NGAL have the highest value.