Value of early diagnosis of sepsis complicated with acute kidney injury by renal contrast-enhanced ultrasound

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 7^th 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: Acute kidney injury; Contrast-enhanced ultrasound; Peak intensity; Sepsis; Serum creatinine; Wash in slope.

Figure 1

Grouping diagram of sepsis patients based on acute kidney injury diagnostic criteria. AKI: Acute kidney injury.

Figure 2

Contrast-enhanced ultrasound in patients with septic acute kidney injury and non-acute kidney injury sepsis. A: Contrast-enhanced ultrasound (CEUS) time-intensity curve (TIC) for patients with non-acute kidney injury (AKI) sepsis; B: CEUS TIC for patients with septic AKI.

Figure 3

Receiver operating characteristic analysis of each potential indicator for the diagnosis of septic acute kidney injury. A: Clinical indicators (Systemic inflammatory response score, blood lactic acid, serum creatinine, blood urea nitrogen) for the diagnosis of septic acute kidney injury (AKI); B: Contrast-enhanced ultrasound indicators (Peak intensity, wash in slope, rise time) for the diagnosis of sepsis AKI. SIRS: Systemic inflammatory response score; Lac: Blood lactic acid; Scr: Serum creatinine; BUN: Blood urea nitrogen; WIS: Wash in slope; PI: Peak intensity; RT: Rise time.

Figure 4

Receiver operating characteristic analysis of the combined diagnosis of serum creatinine, wash in slope, and peak intensity for septic acute kidney injury. AUC: Area under curve.