Predictive value of pathogenic bacteria and levels of HMGB1, sFlt-1, miR-21-3p and miR-578 for development of acute kidney injury in patients with sepsis

OBJECTIVE To explore the predictive value of pathogenic bacteria culture and drug sensitivity results, as well as the levels of high mobility group box 1 protein (HMGB1), soluble fms-like tyrosine kinase-1 (sFlt-1), microRNA (miR)-21-3p and miR-578, for the development of acute kidney injury (AKI) in patients with sepsis in the intensive care unit (ICU).

METHODS A total of 286 patients with sepsis admitted to the ICU of the Yichang Central People′s Hospital from Nov. 2021 to Nov. 2024 were selected and divided into AKI and non-AKI groups (139 cases and 147 cases, respectively) based on whether they had concurrent AKI. The pathogenic bacteria and drug sensitivity results of patients with sepsis in the ICU were statistically analyzed. The levels of serum HMGB1, sFlt-1, miR-21-3p and miR-578 were compared between the two groups, and the predictive value of these four markers for sepsis complicated with AKI was analyzed.

RESULTS Among 286 patients with sepsis in the ICU, 148 strains were isolated. Most of the isolated bacteria were gram-negative, with Acinetobacter baumannii and Staphylococcus aureus being the predominant gram-negative and gram-positive bacteria, respectively. A. baumannii exhibited high resistance to ciprofloxacin, ceftriaxone, ceftazidime and cefepime, but low resistance to minocycline. S. aureus showed high resistance to penicillin and erythromycin, but low resistance to linezolid, tigecycline and vancomycin. The levels of serum HMGB1, sFlt-1 and miR-21-3p were higher in the AKI group than those in the non-AKI group (P < 0.05), while the level of miR-578 was lower (P < 0.05). The combined detection of these four markers showed a higher AUC value for diagnosing ICU sepsis complicated with AKI than that of the individual markers (P < 0.05), with a sensitivity of 88.50% and a specificity of 74.80%.

CONCLUSIONS Sepsis infections in the ICU are mostly caused by gram-negative bacteria, such as A. baumannii and S. aureus. It is recommended to use minocycline, linezolid, tigecycline and vancomycin for these infections. HMGB1, sFlt-1, miR-21-3p and miR-578 are involved in the occurrence of sepsis complicated with AKI, and the combined detection of these four markers has high predictive value.