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A prediction model of sepsis-associated acute kidney injury based on antithrombin III

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Abstract

The incidence of sepsis-associated acute kidney injury (AKI) is on the rise. Recent studies have found a correlation between antithrombin III and AKI. We established a predictive model for sepsis-associated AKI based on plasma ATIII levels. A prospective study (March 2018–January 2020) was conducted in sepsis patients admitted to the Critical Care Medicine Department at Shanghai General Hospital. ATIII levels were obtained within 48 h after admission to the ICU and before the diagnosis of sepsis-associated AKI was recorded. Renal function was assessed by measuring serum creatinine levels and urine volume. Male sex, other cardiovascular disease, and low ATIII levels were identified as independent risk factors for AKI. Age, immune disease, and low ATIII levels were identified as independent risk factors for death. Plasma ATIII levels in the non-AKI group were higher than those in the AKI group, plasma ATIII levels were higher in the survival group than in the non-survival group, plasma ATIII levels in the non-CRRT group were higher than those in the CRRT group, and plasma ATIII levels in the non-CKD group were higher than those in the CKD group. ATIII was significantly higher in the group with pulmonary infection than in the group without pulmonary infection. ATIII was significantly lower in the celiac infection group than in the nonceliac infection group. There was no statistically significant difference between the ATIII in the gram-positive group and the gram-negative group. ATIII was significantly higher in medical patients than in surgical patients. The predictive model of sepsis-associated AKI established based on ATIII was ln[P/(1 − p)] = −1.211 × sex − 0.017 × ATIII + 0.022 × Cr + 0.004 × BUN − 2.8192. The model goodness-of-fit test (p = 0.000) and the area under the ROC curve of the model (0.9862) suggested that the model has a high degree of discrimination and calibration. ATIII reduction was closely related to the prognosis of patients with sepsis. ATIII reduction was an independent risk factor for sepsis-associated AKI and an independent risk factor for mortality in patients with sepsis. ATIII reduction could predict sepsis-associated AKI. Low ATIII predicted a poor prognosis.

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All data generated or analyzed during this study are included in this published article.

Abbreviations

APACHE II:

Acute Physiology and Chronic Health Evaluation II score

SOFA:

Sepsis-related organ failure assessment

COPD:

Chronic obstructive pulmonary disease

ICU:

Intensive care unit

AKI:

Acute kidney injury

CRRT:

Continuous renal replacement therapy

ATIII:

Antithrombin III

KDIGO:

Kidney Disease Improving Global Outcomes

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Funding

The present study was supported by grants from Shanghai Science and Technology Committee Scientific and Technological Support Project (Grant Nos. 18411950600 and 18411950602, respectively), Clinical Research Innovation Plan of Shanghai General Hospital (Grant No. CTCCR-2016B01) Wu Jieping Medical Foundation (Grant No. 320.6750.18546), and Songjiang district science and technology Project (19SJKJGG92).

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Author notes

  1. Yun Xie, Yi Zhang and Rui Tian have contributed equally to this work.

Authors and Affiliations

  1. Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 New Songjiang Road, Songjiang, 201600, Shanghai, People’s Republic of China

    Yun Xie, Rui Tian, Wei Jin, Jiang Du, Zhigang Zhou & Ruilan Wang

  2. Department of Rheumatology, The Second Affiliated Hospital of Soochow University, Suzhou, China

    Yi Zhang

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  1. Yun Xie
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  4. Wei Jin
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  7. Ruilan Wang
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Contributions

YX, YZ, and RT were involved in conception and design; RW, RT, and ZZ were involved in administrative support; WJ and JD were involved in provision of study materials or patients; YX was involved in collection and assembly of data; YZ was involved in data analysis and interpretation; all authors were involved in manuscript writing. All authors were involved in final approval of manuscript.

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Correspondence to Ruilan Wang.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval was obtained from Shanghai General Hospital Institutional Review Board [Approval No. (2018)KY004].

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Xie, Y., Zhang, Y., Tian, R. et al. A prediction model of sepsis-associated acute kidney injury based on antithrombin III. Clin Exp Med 21, 89–100 (2021). https://doi.org/10.1007/s10238-020-00656-x

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  • DOI: https://doi.org/10.1007/s10238-020-00656-x

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