Diagnostic value of multi-parameter ultrasound evaluation in sepsis complicated by acute kidney injury

Figures & data

Table 1. Renal ultrasound feature scoring criteria.

Parameters	0	1	2	3	4
Renal parenchymal thickness (RPT, mm) Renal artery resistance index (RI)	<8 ≤0.7	9–10 0.75–0.8	11–12 0.85–0.9	13–14 0.95–1.0	≥15 >1
renal pelvis anteroposterior diameter (APD, mm)	<7	7–10	10–13	13–15	≥15

Table 2. Comparisons of baseline characteristics.

	Non-injury group (n = 50)	AKI group (n = 50)	t/χ^2	P
Age (years)	62.46 ± 7.75	61.74 ± 7.96	0.458	0.648
Gender (male/female)	26/24	26/24	0.000	1.000
Body Mass Index, (BMI, kg/m^2)	22.64 ± 1.25	22.27 ± 1.40	1.382	0.170
Kidney disease (yes/no)	44/6	46/4	0.444	0.505
Diabetes mellitus (yes/no)	3/47	3/47	0.000	1.000
Hypertension (yes/no)	6/44	7/43	0.088	0.766
retinopathy (yes/no)	8/42	3/47	2.554	0.110
Peripheral neuropathy (yes/no)	8/42	3/47	2.554	0.110
Uric acid (μmol/L)	325.90 ± 42.35	324.66 ± 47.29	0.138	0.890
Glycosylated hemoglobin	5.04 ± 0.58	5.10 ± 0.83	−0.407	0.685
Blood calcium (mmol/L)	2.42 ± 0.27	2.42 ± 0.12	0.144	0.886
Serum phosphorus (mmol/L)	1.26 ± 0.15	1.27 ± 0.28	−0.044	0.965
Total cholesterol (mmol/L)	4.52 ± 0.63	4.52 ± 0.67	−0.049	0.961
Triacylglycerol (mmol/L)	1.28 ± 0.17	1.28 ± 0.42	−0.047	0.963
Serum albumin (g/L)	43.54 ± 8.84	43.61 ± 6.57	−0.047	0.963
Hemoglobin (g/L)	152.94 ± 25.20	158.56 ± 13.88	−1.382	0.171
Urine protein quantitation (mg/d)	126.58 ± 20.78	126.96 ± 22.64	−0.087	0.931
Urine red blood cell count	15.74 ± 2.54	16.10 ± 2.74	−0.681	0.497
Estimated glomerular filtration rate (eGFR, mL/min/1.73m^2)	158.70 ± 25.42	161.92 ± 15.94	−0.758	0.450
Blood urea nitrogen (mmol/L)	7.33 ± 0.76	7.39 ± 0.30	−0.566	0.573

Enumeration data were expressed as number and χ² test was used for comparison. Measurement data were expressed as mean ± SD, and independent sample t-test was used for comparison.

Figure 1. The representative ultrasound images of patients.

Table 3. Comparisons of renal function in the patients.

	Non-injury group (n = 50)	AKI group (n = 50)	t	P
24-h urine volume (mL)	1348.84 ± 132.25	1203.96 ± 173.27	4.700	<0.001
Serum creatinine (μmol/L)	129.38 ± 14.62	134.81 ± 16.39	−2.834	0.006
Urea (mg/dL)	6.56 ± 2.10	8.17 ± 2.86	−10.348	<0.001
serum cystatin C (mg/L)	0.96 ± 0.26	1.25 ± 0.27	−4.064	<0.001
RPT (mm)	1.98 ± 0.65	2.52 ± 0.58	−4.367	<0.001
RI	1.10 ± 0.71	2.44 ± 0.58	−10.384	<0.001
APD (mm)	2.58 ± 0.61	2.18 ± 0.65	2.933	0.004
MPUS	5.66 ± 1.14	7.14 ± 1.32	−5.997	<0.001

Data were expressed as n or mean ± SD, and independent sample t-test was used for comparison. Renal parenchymal thickness (RPT), renal artery resistance index (RI), renal pelvis anteroposterior diameter (APD) and multi-parameter ultrasound scoring (MPUS) data served as scoring data.

Table 4. Logistic multivariate regression analysis for influencing factors of sepsis complicated with acute kidney injury.

	B	Standard error	Wald	P	OR	95% Confidence interval
						Lower limit	Upper limit
24-h urine volume	−1.097	0.272	16.216	<0.001	3.126	1.256	8.263
Serum cystatin C	1.186	0.242	12.744	<0.001	2.376	1.477	3.820
RPT	1.258	0.850	3.805	0.051	5.247	0.992	20.749
RI	3.968	1.267	9.811	0.002	15.288	4.416	33.437
MPUS	1.935	1.056	3.355	0.007	8.245	2.365	25.623
APACHE II	1.056	0.471	3.126	0.126	0.956	0.425	3.265
SOFA	1.123	0.589	3.629	0.057	3.073	0.968	9.756

Renal parenchymal thickness (RPT), renal artery resistance index (RI), renal pelvis anteroposterior diameter (APD) and multi-parameter ultrasound scoring (MPUS) data acted as scoring data.

Figure 2. Receiver operating characteristic (ROC) curve for 24-h urine volume, serum cystatin C, renal artery resistance index (RI), and multi-parameter ultrasound scoring (MPUS).

Table 5. Receiver operating characteristic (ROC) curve analysis for related indicators of patients with septic AKI.

	Area under the curve (AUC)	P	95% CI	Cut-off value	Sensitivity	1-specificity
24-h urine volume	0.797	<0.001	0.709–0.885	1276	0.74	0.26
Serum cystatin C	0.730	<0.001	0.629–0.831	1.315	0.72	0.28
Renal artery resistance index (RI)	0.906	<0.001	0.849–0.964	1.5	0.96	0.26
Multi-parameter ultrasound scoring (MPUS)	0.794	<0.001	0.707–0.881	6.5	0.68	0.24

Data availability statement

Datasets used in this article are available from the corresponding author on reasonable request.