Background: Sepsis patients suffer from severe inflammation and poor prognosis. Oxidative stress and local inflammation that results from sepsis can trigger organ injury, including acute kidney injury (AKI).Previous studies have shown that heme oxygenase-1 (HO-1) is overexpressed in proximal tubular cells under oxidative stress and has significant cytoprotective and anti-inflammatory effects. Heme-induced inflammation in sepsis is antagonized by increased tissue expression of heme oxygenase-1 (HO-1), which impacts on AKI development. The investigators observed intrarenal HO-1 expression and corresponding potential increases in plasma and urinary HO-1 protein concentrations in four different AKI models. Since serum levels of HO-1 reflect HO-1 expression, we aimed to investigate whether serum HO-1 could predict the development of AKI in sepsis patient.Methods: A total of 83 sepsis patients were enrolled in this study including septic patients with AKI and sepsis patients without AKI. According to the definition of septic shock and the global kidney diagnostic criteria described in the Kidney Disease: Improving Global Outcomes (KDIGO), patients were allocated to the sepsis and septic shock groups with and without AKI, respectively. The serum levels of HO-1 were measured by enzyme-linked immunosorbent assays (ELISA). Statistical analyses were performed using SPSS software.Results: There were statistically significant differences between septic patients with AKI and sepsis patients without AKI in terms of Sequential Organ Failure Assessment (SOFA) score, hospitalization time, and laboratory indicators including serum HO-1, creatine kinase MB (CK-MB), troponin I (TnI), urea, myoglobin (MYO), serum creatinine (Scr), procalcitonin, and activated partial thromboplastin time. Serum levels of alkaline phosphatase (ALP), urea, MYO, Scr, procalcitonin, activated partial thromboplastin time, and prothrombin time exhibited significant differences among the four groups. The concentration of serum HO-1 was higher in sepsis-induced AKI compared with sepsis patients without AKI. Serum HO-1 levels were increased in patients with sepsis shock-induced AKI. The area under the receiver operating characteristic (ROC) curve for serum HO-1 combined with Scr was 0.885 [95% confidence interval (CI): 0.761-1.000].Conclusions: Serum HO-1 is positively correlated with sepsis-induced AKI. These findings suggest that measurement of serum HO-1 may play a diagnostic and prediction role in sepsis-induced AKI.
Background Sepsis patients suffer from severe inflammatory and poor prognosis. Local inflammation resulted from sepsis is found to trigger organ injury, such as acute kidney injury (AKI). We conducted a cross-sectional observational study to examine the diagnostic and prognostic role of serum heme oxygenase 1 (HO-1) on sepsis-induced AKI. Methods The 83 enrolled patients were initially divided into two groups with no AKI (NAKI) and sepsis-induced AKI group (SAKI) based on whether had AKI. Then the patients were concretely divided into four groups: septic shock and AKI group (SS+AKI group), sepsis-induced AKI group (S+AKI group), septic shock group (SS group), and sepsis group (S group. The venous blood was sampled within 24 hours after diagnosis of sepsis. We detected the serum HO-1 and laboratory indicators by enzyme-linked immunosorbent assay. The 28-day survival status was observed between the HO-1 high- and low-level patients grouped by the median of HO-1 concentration 41.33U/L. Results We found that there were statistically significant results of SOFA score and admission time between SAKI and NAKI group (p<0.05). The level of HO-1 in SAKI group was obviously elevated as compared with NAKI group (p<0.05). It was remarkable to show that HO-1 level was remarkably higher in SS+AKI group than that in other three groups (p<0.05). In All groups, HO-1 positively correlates with SOFA score, Scr, Hb, APTT, Urea, and TnI (p<0.05). In SS+AKI group, HO-1 was positively associated with SOFA score, Scr, AKI stage, γ-GT, and FDP (p<0.05). In S+AKI, HO-1 level was positively related to the level of Scr, AKI stage, and ALP (p<0.05). In SS group, SOFA score was in negative correlation to HO-1 (p<0.05). The AUC of HO-1 and serum creatinine was 0.824 (95% CI: 0.703-0.944) and 0.778 (95% CI: 0.658-0.919) separately. The AUC of combined with HO-1 and serum creatinine was 0.864 (95% CI: 0.761-0.968). The survival analysis showed that sepsis patients with high HO-1 level had a higher mortality rate compared with patients with low HO-1 expression. Conclusions The findings from this study make contributions to clinical value of HO-1, suggesting that HO-1 plays a diagnostic and prognostic role in sepsis-induced AKI.
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