Predictive value of color doppler ultrasound combined with ICAM-1 and VCAM-1 for acute kidney injury in patients with septic shock

OBJECTIVE To investigate the levels of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in patients with septic shock, and to analyze the predictive value of each index combined with color Doppler ultrasound (CDUS) for the occurrence of acute kidney injury (AKI).

METHODS Patients with septic shock admitted to the Second People′s Hospital of Gansu Province from Aug. 2019 to Aug. 2023 were selected, and a total of 102 cases were included, patients who developed AKI were included in the AKI group (39 cases), while patients who did not develop AKI were included in the non-AKI group (63 cases). The clinical data, CDUS results, and levels of ICAM-1, VCAM-1 between the two groups were compared, and the correlation between CDUS results, ICAM-1, VCAM-1 and renal function indicators were analyzed by Pearson correlation analysis. The predictive values of CDUS examination results, ICAM-1, VCAM-1 for AKI in patients with septic shock were analyzed by receiver operating characteristic (ROC) curves.

RESULTS The level of lactate in the AKI group was (3.54±0.98) mmol/L, which was lower than that in the non-AKI group; Serum creatinine (Scr) and urea nitrogen (BUN) were (241.65±82.65) μmol/L and (22.65±8.76) mmol/L, respectively, which were higher than those in the non-AKI group (P < 0.05). The renal artery resistance index (RI), pulsatility index (PI) and the levels of ICAM-1 and VCAM-1 in the AKI group were (0.98±0.12), (2.03±0.24), (20.54±7.54) ng/ml, and (1454.32±711.32) pg/ml, respectively, which were higher than those in the non-AKI group (P < 0.05). The renal artery RI and PI, as well as serum ICAM-1 and VCAM-1 in the AKI group were positively correlated with Scr and BUN (P < 0.05). The area under the curve (AUC) were 0.774, 0.714, 0.725, 0.676 and 0.889, respectively, and the AUC of the combined detection was higher than that of the individual detection (P < 0.05).

CONCLUSION AKI can lead to a decline in renal function in patients with septic shock, the expression of renal artery RI, PI, serum ICAM-1, VCAM-1 are closely related to the patient′s renal function. CDUS, ICAM-1 and VCAM-1 have high predictive values for AKI occurrence, combined detection has higher predictive value than individual detection.