THE VALUE OF NGAL, KIM-1 AND IL-18 FOR THE EARLY DIAGNOSIS OF SEPTIC SHOCK WITH ACUTE KIDNEY INJURY

Yingqun Chen^1#, Jinbin Wu^2#, Zihan Yin¹, Xuwei Lin¹, Weixing Zhang^1*

¹Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518000, China - ²Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518000, China.

Introduction: To explore the clinical value of combined detection of serum and urinary neutrophil gelatinase-associated lipocalin (NGAL), urinary interleukin-18 (IL-18) and urinary kidney injury molecule-1 (KIM-1) in the evaluation of treatment effect of sepsis-induced acute kidney injury (AKI).

Materials and methods: A total of 100 sepsis-induced AKI patients admitted to our hospital from January 2020 to June 2021 were collected and randomly divided into a control group (n=50, conventional treatment) and an observation group (n=50, CRRT standardized treatment). The levels of serum NGAL (sNGAL), urinary NGAL (uNGAL), KIM-1 and IL-18 at 0, 12, 24, and 48 h after admission were detected, and the Acute Physiology and Chronic Health Evaluation (APACHE II) and mortality in the two groups were observed and recorded.

Results: The patients in the observation group and the control group at different time points were compared according to different clinical stages of RISK (stage I), INJURY (stage II), and FAILURE (stage III). The levels of uNGAL, KIM-1 and IL-18 in the observation group at 12, 24, and 48 h were significantly lower than those at 0 h (P<0.05). At the same time point, compared with the control group, the levels of sNGAL, uNGAL, KIM-1 and IL-18 in the observation group were significantly reduced at 12, 24, and 48 h (P<0.05). The results of linear correlation analysis showed that the levels of sNGAL, uNGAL, KIM-1, and IL-18 in sepsis-induced AKI had a significantly positive correlation with the severity of the disease, and the Person correlation coefficient was positive (P<0.05). The area under the ROC curve for the four biomarkers individually and in combination was sNGAL, uNGAL, KIM-1 and IL-18 in descending order; in the combined detection of NGAL, uNGAL, KIM-1 and IL-18, the sensitivity of the parallel detection was 92.0%, and the specificity of the tandem detection (adopted) was 95.0%, which were significantly higher than those of the detection of individual biomarkers (P<0.05).

Conclusion: CRRT standardized treatment can significantly reduce the levels of sNGAL, uNGAL, KIM-1 and IL-18 in sepsis-induced AKI patients; combined detection of sNGAL, uNGAL, KIM-1 and IL-18 can be used as the important biological indicators for evaluating sepsis-induced AKI.