Serum Procalcitonin Level Predicts Acute Kidney Injury After Traumatic Brain Injury
Serum Procalcitonin Level Predicts Acute Kidney Injury After Traumatic Brain Injury
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DOI：
10.1016/j.wneu.2020.04.245
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发表时间：
2020-09-01
影响因子：
2
通讯作者：
Kang, Yan
中科院分区：
文献类型：
--
作者：
Wang, Ruoran;He, Min;Kang, Yan
背景：急性肾损伤（AKI）是创伤性脑损伤（TBI）后常见的非神经系统并发症，是死亡的危险因素。一些研究证实了降钙素原（PCT）在一些临床情况下对AKI的预测价值。我们设计这项研究是为了探讨PCT对TBI后AKI的预测价值。方法：回顾性纳入2015年2月至2019年6月在我院住院的TBI患者。通过多因素logistic回归分析，寻找AKI的危险因素，建立AKI的预测模型。绘制受试者工作特征曲线，比较PCT与所建模型的预测值。结果：本研究共纳入214例患者。本研究TBI后AKI发生率为25.70%。与非AKI组相比，AKI组患者年龄较高（P = 0.031），格拉斯哥昏迷评分较低（P < 0.001），凝血功能障碍发生率较高（P < 0.001），休克发生率较高（P < 0.001）。此外，合并AKI的患者住院死亡率较高（P < 0.001）， 90天预后较差（P < 0.001）。多因素logistic回归分析显示，年龄（P = 0.033）、PCT （P = 0.002）、血清氯（P = 0.011）、肌酐（P < 0.001）是AKI的独立危险因素。我们利用这4个危险因素构建了一个预测模型。预测模型的受试者工作特征曲线下面积为0.928，显著高于单一PCT值（受试者工作特征曲线下面积= 0.833）（Z = 2.395, P < 0.05）。结论：PCT对预测TBI后AKI有价值。为避免脑外伤后AKI，医生可根据PCT水平调整治疗策略。
BACKGROUND: A common non-neurologic complication after traumatic brain injury (TBI), acute kidney injury (AKI) is a risk factor of mortality. Some studies confirmed the predictive value of procalcitonin (PCT) on AKI in several clinical settings. We designed this study to explore the predictive value of PCT on AKI after TBI.METHODS: We retrospectively enrolled patients with TBI admitted to our hospital from February 2015 to June 2019. Multivariate logistic regression analysis was performed to find the risk factors of AKI and construct a predictive model for AKI. Receiver operating characteristics curves were drawn to compare the predictive value of PCT and the constructed model.RESULTS: A total of 214 patients were included in this study. The incidence of AKI after TBI was 25.70% in this study. Compared with the non-AKI group, the AKI group had higher age (P = 0.031), lower Glasgow Coma Scale (P < 0.001), and higher incidence of coagulopathy (P < 0.001) and shock (P < 0.001). Moreover, patients complicated with AKI had higher in-hospital mortality (P < 0.001) and worse 90-day outcome (P < 0.001). Multivariate logistic regression analysis indicated that age (P = 0.033), PCT (P = 0.002), serum chlorine (P = 0.011), and creatinine (P < 0.001) were independent risk factors of AKI. We constructed a predictive model using these 4 risk factors. The area under receiver operating characteristics curves of the predictive model was 0.928, which was significantly higher than that of a single PCT value (area under receiver operating characteristics curves = 0.833) (Z = 2.395, P < 0.05).CONCLUSIONS: PCT is valuable in predicting AKI after TBI. To avoid AKI after TBI, physicians can adjust treatment strategies according to the level of PCT.