The predictive performance of the lactate clearance rate combined with the APACHE II score in the prediction of sepsis-associated acute kidney injury in 7 days

Yezhou Shen; Jiaoyang Yu; Fei Zhou; Juzhen Yan; Jing Yang; Ying Guo; Leqing Lin

doi:10.21037/tau-22-225

The predictive performance of the lactate clearance rate combined with the APACHE II score in the prediction of sepsis-associated acute kidney injury in 7 days

Transl Androl Urol. 2022 Apr;11(4):543-553. doi: 10.21037/tau-22-225.

Authors

Yezhou Shen¹, Jiaoyang Yu¹, Fei Zhou¹, Juzhen Yan², Jing Yang³, Ying Guo^{4

5}, Leqing Lin¹

Affiliations

¹ Intensive Care Unit, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
² Department of Kidney Disease, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
³ Center of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
⁴ Department of Emergency Medicine, Faculty of Medicine, Hangzhou Normal University, Hangzhou, China.
⁵ Intensive Care Unit, Jingmen No. 1 People's Hospital, The Affiliated Hospital of Hubei Minzu University, Jingmen, China.

Abstract

Background: The purpose of this study was to evaluate the accuracy of the lactate clearance rate (LCR) combined with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in the prediction of sepsis-associated acute kidney injury (SAKI).

Methods: Sepsis patients were divided into the SAKI group and non-SAKI group. Arterial blood lactate was collected at 0 h (before treatment), 2 h, 4 h, 6 h, and 8 h (after treatment), and the LCR was calculated. The physiological parameters and laboratory test results were used to calculate the APACHE II score and the Sequential Organ Failure Assessment (SOFA) score. The receiver operating characteristic (ROC) curves of LCR, APACHE II score and SOFA score for predicting patients with SAKI were drawn. Two single indicators with high areas under the curves (AUCs) were selected to calculate the joint probability through regression analysis, and the prediction efficiency corresponding to each curve was analyzed.

Results: There were significant differences in LCR between different groups and time periods (F^group=17.44, P^group ≤0.0001, F^time =11.71, P^time =0.0014). After 8 h of treatment, there was a significant difference in the overall compliance rate between the 2 groups (P<0.0001). In addition, after 24 h of treatment, the APACHE II score in the SAKI group was significantly higher than that in the non-SAKI group (P=0.0007), and SOFA score was also significantly higher than that in the non-SAKI group (P=0.0001). ROC curve showed that the 0-8 h LCR and APACHE II scores had a high predictive performance for the acute kidney injury (AKI) occurrence in sepsis patients, and AUCs were 0.7637 and 0.7517, respectively, while the combined AUC of the 2 indicators was 0.7975.

Conclusions: The 0-8 h LCR combined with APACHE II score can improve the early predictive value of SAKI, reduce the risk of AKI in patients with sepsis/septic shock, and reduce the social and family burden, which is worthy of clinical application.

Keywords: Acute Physiology and Chronic Health Evaluation II (APACHE II) score; Lactate clearance rate (LCR); sepsis-associated acute kidney injury (SAKI).