Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 3934-3944
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.3934
Value of early diagnosis of sepsis complicated with acute kidney injury by renal contrast-enhanced ultrasound
Xiu-Yan Wang, Yan-Ping Pang, Tian Jiang, Shuo Wang, Jiang-Tao Li, Bao-Min Shi, Chen Yu
Xiu-Yan Wang, Yan-Ping Pang, Tian Jiang, Shuo Wang, Department of Ultrasound, Tongji Hospital of Tongji University, Shanghai 200065, China
Jiang-Tao Li, Chen Yu, Department of Nephrology, Tongji Hospital of Tongji University, Shanghai 200065, China
Bao-Min Shi, Department of General Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China
Author contributions: Wang XY and Pang YP contributed equally to this manuscript; Wang XY, Pang YP, Shi BM, and Yu C designed the research; Wang XY, Pang YP, Jiang T, Li JT, and Yu C performed the research; Pang YP, Wang S, and Shi B contributed new analytic tools; Wang XY, Wang S, Li JT, and Yu C analyzed the data; and Wang XY, Pang YP, Jiang T, Wang S, Li JT, Shi BM, and Yu C wrote the paper.
Supported by National Natural Science Foundation of China, No. 81873609.
Institutional review board statement: The study was approved by the ethics committee of Tongji Hospital of Tongji University.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bao-Min Shi, PhD, Chief Physician, Professor, Department of General Surgery, Tongji Hospital of Tongji University, No. 389 Xincun Road, Putuo District, Shanghai 200065, China. baominsph@163.com
Telephone: +86-18019178659
Received: September 6, 2019
Peer-review started: September 6, 2019
First decision: October 24, 2019
Revised: October 30, 2019
Accepted: November 20, 2019
Article in press: November 20, 2019
Published online: December 6, 2019
Abstract
BACKGROUND

The incidence of acute kidney injury (AKI) in patients with sepsis is high, and the prognosis of patients with septic AKI is poor. The early diagnosis and treatment of septic AKI is of great significance in improving the prognosis of patients with sepsis.

AIM

To explore the value of contrast-enhanced ultrasound (CEUS), serum creatinine (Scr), and other indicators in the early diagnosis of septic AKI.

METHODS

Ninety patients with sepsis during hospitalization at Tongji Hospital of Tongji University were recruited as subjects. Each patient was recorded with relevant basic data, clinical indicators, and CEUS results. The patients were divided into AKI group and non-AKI group according to the results of renal function diagnosis after 48 h. On the 7th day, the renal function of the non-AKI group was re-evaluated and the patients were further divided into AKI subgroup and non-AKI subgroup. The differences of the indicators in different groups were compared, and the diagnostic value of each indicator and their combination for septic AKI was analyzed.

RESULTS

Systemic inflammatory response score (2.58 ± 0.75), blood lactic acid (3.01 ± 1.33 mmol/L), Scr (141.82 ± 27.19 μmol/L), blood urea nitrogen (4.41 ± 0.81mmol/L), and rise time (10.23 ± 2.63 s) in the AKI group were higher than those in the non-AKI group. Peak intensity (PI) (10.78 ± 3.98 dB) and wash in slope (WIS) (1.07 ± 0.53 dB/s) were lower than those in the non-AKI group. The differences were statistically significant (P < 0.05). The PI (12.83 ± 3.77 dB) and WIS (1.22 ± 0.68 dB/s) in the AKI subgroup were lower than those in the non-AKI subgroup, and the differences were statistically significant (P < 0.05). The area under curve (AUC) of Scr for the diagnosis of septic AKI was 0.825 with a sensitivity of 56.76% and a specificity of 100%. The AUCs of WIS and PI (0.928 and 0.912) were higher than those of Scr. Their sensitivities were 100%, but the specificities were 71.70% and 75.47%. The AUC of the combination of three indicators for the diagnosis of septic AKI was 0.943, which was significantly higher than the AUC diagnosed by each single indicator. The sensitivity was 94.59%, and the specificity was 81.13%.

CONCLUSION

The combination of Scr, PI, and WIS can improve the diagnostic accuracy of septic AKI. PI and WIS are expected to predict the occurrence of early septic AKI.

Keywords: Sepsis, Acute kidney injury, Serum creatinine, Contrast-enhanced ultrasound, Peak intensity, Wash in slope

Core tip: Early detection of risk factors for septic acute kidney injury (AKI) and early intervention are important for the treatment of patients with sepsis. Currently, serum creatinine (SCr) is used as the criterion for AKI diagnosis. But SCr has obvious hysteresis and poor sensitivity, and it is difficult to predict the occurrence of early septic AKI. In this study, contrast-enhanced ultrasound techniques were utilized to explore the value of early diagnosis of septic AKI, and it revealed that the combination of SCr, peak intensity, and wash in slope (contrast-enhanced ultrasound indicators) can improve the early diagnosis of septic AKI.