THE DIAGNOSTIC AND PREDICTIVE VALUE OF URINE NGAL, IGFBP-7 AND STREM-1 IN SEPSIS ACUTE KIDNEY INJURY

Junling Huang, Dongfeng Guo^*

Department of Emergency Medicine, Gongli Hospital of Shanghai Pudong New Area

Objective: To analyze the diagnostic and predictive value of urinary neutrophil gelatinase-related lipid transporter (NGAL), insulin-like growth factor binding protein 7 (IGFBP-7), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in sepsis-associated acute kidney injury (AKI). 

Methods: A total of 153 patients with sepsis admitted to our hospital from January 2018 to January 2020 were analyzed. The subjects were divided into AKI (n=71) and non-AKI (n=82) groups according to whether the patients had complications associated with AKI. Urine samples of all patients were collected at 0, 3, 6, 12, 24, and 48 hours after admission, and the levels of NGAL, IGFBP-7, and sTREM-1 were detected by enzyme-linked immunosorbent assay (ELISA) and compared between groups. Pearson linear correlation was used to analyze the correlation of each factor level change. 

Results: At 0 h after admission, there was no significant difference in NGAL, IGFBP-7, and sTREM-1 concentrations in both patient groups’ urine (P>0.05). After 6 h at admission, NGAL and sTREM-1 levels in the AKI group were significantly higher than in the non-AKI group. After admission for 3 hours, the IGFBP-7 level in the urine of patients in the AKI group was significantly higher than that in the non-AKI group, and the difference was statistically significant (P<0.05). NGAL was significantly positively correlated with IGFBP-7 and sTREM-1 (r=0.512, 0.469, P<0.05 or <0.01); IGFBP-7 was significantly positively correlated with sTREM-1 (r=0.583, P<0.05). ROC curve analysis showed that the AUC of NGAL diagnosis of sepsis complicated with AKI was 0.759, and the optimal cut-off value was 84.68 ng/mL. The sensitivity at this point was 71.26%, and the specificity was 73.16%. The AUC of IGFBP-7 for diagnosis of sepsis complicated with AKI was 0.887, and the optimal cut-off value was 1.26 ng/mL. The sensitivity at this point was 86.32%, and the specificity was 84.29%. The AUC for NGAL diagnosis of sepsis complicated with AKI was 0.826, the optimal cut-off value was 75.26 ng/mL, the sensitivity was 82.36%, and the specificity was 83.14%. The AUC of the combined diagnosis of sepsis complicated with AKI was 0.942, the sensitivity was 92.47%, and the specificity was 93.35%. 

Conclusion: NGAL, IGFBP-7, and sTREM-1 are highly expressed in the urine of patients with early sepsis complicated with AKI and may be particularly valuable in clinics for the diagnosis of sepsis complicated with AKI.