The expression and clinical significance of serum CAF and penKid in sepsis-induced acute kidney injury

Li Ping; Wang Shuo; Wang Ling; Wang Wei; Wang Xiujuan

doi:10.3969/j.issn.1671-6450.2025.04.003

Abstract：Objective To investigate the expression levels and clinical significance of serum C-terminal agrin frag-ment(CAF)and proenkephalin a 119-159(penKid)in patients with sepsis complicated with acute kidney injury(AKI).Met-hods A total of 109 patients with sepsis complicated with AKI admitted to the Department of Intensive Care Medicine,the Fourth Affiliated Hospital of Nanjing Medical University from March 2021 to March 2024 were selected as the AKI group.According to the AKI staging criteria,they were divided into stage Ⅰ(n=46),stage Ⅱ(n=35)and stage Ⅲ(n=28).All pa-tients were treated with renal replacement therapy(CRRT).According to the estimated glomerular filtration rate(eGFR)at 28 days after treatment,they were divided into good prognosis subgroup(n=83)and poor prognosis subgroup(n=26);109 patients with simple sepsis were randomly selected as sepsis group.Serum CAF and penKid levels were detected by en-zyme-linked immunosorbent assay,serum creatinine(SCr),cystatin C(Cys-C)and estimated glomerular filtration rate(eGFR)were detected by automatic biochemical analyzer;Pearson product moment correlation or Spearman rank correlation was used to analyze the relationship between serum CAF,penKid and renal function index,AKI stage;logistic regression analy-sis was used to analyze the adverse prognostic factors in patients with sepsis complicated with AKI;the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum CAF and penKid for poor prognosis.Results Compared with the sepsis group,the levels of serum CAF and penKid,SCr and Cys-C in the AKI group were increased,and the level ofeGFRwas decreased(t/P=15.363/＜0.001,12.104/＜0.001,18.038/＜0.001,19.221/＜0.001,20.776/＜0.001).The levels of serum CAF and penKid in patients with stage Ⅰ,stage Ⅱ and stage Ⅲ increased in turn,the levels of SCr and Cys-C increased in turn,and the levels of eGFR decreased in turn,the differences were statistically significant(F/P=95.573/＜0.001,49.832/＜0.001,85.548/＜0.001,79.249/＜0.001,421.846/＜0.001).Serum CAF and penKid were positively correlated with AKI stage,positively correlated with SCr and Cys-C,and negatively correlated with eGFR(CAF:rs/P=0.762/＜0.001,0.703/＜0.001,0.715/＜0.001,-0.771/＜0.001;penKid:rs/P=0.734/＜0.001,0.668/＜0.001,0.694/＜0.001,-0.702/＜0.001).Compared with the good prognosis subgroup,the proportion of AKI stage Ⅱ and stage Ⅲ,the levels of serum CAF and penKid in the poor prognosis subgroup were increased,and the levels of eGFR was decreased(x2/t/P=10.085/0.007,18.446/＜0.001,11.075/＜0.001,15.252/＜0.001).AKI stage Ⅱ and stage Ⅲ,elevated CAF,elevated penKid were independent risk factors for poor prognosis in patients with sepsis and AKI[OR(95％CI)=1.130(1.032-1.236),1.783(1.246-2.558),1.586(1.157-2.173),1.533(1.127-2.085)],elevated eGFR was a protective factor for poor prognosis[OR(95％CI)=0.671(0.483-0.933)];The AUC of serum CAF,penKid and their combination in predicting the poor prognosis of sepsis patients with AKI were 0.831,0.822 and 0.916,respectively.The combination of the two was superior to their respective predictive values(Z=1.624,1.826,P=0.032,0.025).Conclusion The expression of serum CAF and penKid is up-regulated in patients with sepsis complicated with AKI,and is closely related to the severity and prognosis of AKI.Early combined detection can assist clinical prediction of the risk of poor prognosis.