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, 19 (2), 1024-1032

Antithrombin III Expression Predicts Acute Kidney Injury in Elderly Patients With Sepsis

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Antithrombin III Expression Predicts Acute Kidney Injury in Elderly Patients With Sepsis

Yun Xie et al. Exp Ther Med.

Abstract

Elderly people represent the age group most frequently affected by acute kidney injury (AKI). The potential of Antithrombin III (ATIII) level for predicting AKI among elderly patients with sepsis is yet to be elucidated. Therefore, the purpose of the present study was to evaluate the ability of ATIII to predict AKI nondevelopment and prognosis in elderly patients with sepsis, in an intensive care unit (ICU). The present study was retrospective and included 107 elderly patients with sepsis who had been admitted to ICUs between October 2015 and March 2018. An assessment of renal function was performed daily by measuring serum creatinine (Cr) level and urine output, and ATIII level was obtained within 48 h of sepsis diagnosis. Among all enrolled patients, 29 (27.1%) developed AKI. ATIII expression was a predictor of AKI nondevelopment [Area under the curve (AUC)-Receiving operator characteristic (ROC)=0.729; sensitivity, 0.700; specificity, 0.714], and the ATIII/Creatine ratio was also a predictor of AKI nondevelopment (AUC-ROC=0.971; sensitivity, 0.900; specificity, 1). The accuracy of ATIII (AUC-ROC=0.681; sensitivity, 0.802; specificity, 0.542) and ATIII/Cr (AUC-ROC=0.804; sensitivity, 0.596; specificity, 0.875) in predicting survival was intermediate. However, the ATIII serum level was able to accurately predict AKI nondevelopment in elderly patients with sepsis, who were admitted to ICUs. Patients were divided into low- and high-ATIII groups using either 66.95% or 55.7% as cut-off values, both of which were used for further analysis. By comparison, the ICU stay was significantly lower in the high-ATIII group [P=0.020 (69.95%) and 0.049 (55.7%)] and off mechanical ventilation time, off continuous renal replacement therapy time and survival time were significantly higher in the high ATIII group [P=0.049, 0.048, and 0.014, respectively (66.95%); and P=0.041, 0.036, and 0.021, respectively (55.7%)]. The current study indicated that ATIII serum level predicts AKI in elderly patients with sepsis, and that low ATIII levels predicted a poorer prognosis.

Keywords: acute kidney injury; antithrombin III; biomarker.

Figures

Figure 1.
Figure 1.
Flow chart describing the research method.
Figure 2.
Figure 2.
Serum ATIII and ATIII/Cr value in AKI. (A) Serum ATIII values based on development of acute kidney injury. (B) Serum ATIII/Cr values based on development of acute kidney injury. (C) Serum ATIII values based on outcome. (D) Serum ATIII/Cr values based on outcome. ATIII, antithrombin III; Cr, creatine; AKI, acute kidney injury.
Figure 3.
Figure 3.
ROC analysis of ATIII in elderly patients with sepsis with AKI vs. non-AKI. (A) Analysis of ATIII measured within the first 48 h of admission to the ICU (B) Analysis of ATIII/Cr measured within the first 48 h of admission to the ICU. (C) Analysis of ATIII measured within the first 48 h of admission to the ICU (survivors vs. non-survivors). (D) Analysis of ATIII/Cr measured within the first 48 h of admission to the ICU (survivors vs. non-survivors). ROC, receiver operator characteristic; ATIII, antithrombin III; ICU, intensive care unit; Cr, creatine.

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