[The value of renal resistance index and urine oxygen pressure for prediction of acute kidney injury in patients with septic shock].

Objective: To explore the value of renal resistance index (RI) and urine oxygen pressure for early prediction of acute kidney injury (AKI) in patients with septic shock. Methods: Patients with septic shock were enrolled from August 2018 to November 2018 in intensive care unit (ICU) at Peking Union Medical College Hospital. Subjects' general information and AKI characteristics were assessed. Area under the receiver operating characteristic (ROC) curve was used to analyze the predictive value of RI, urine oxygen pressure, or combination of RI on the occurrence of AKI. Results: A total of 72 septic shock patients were enrolled including 29 patients with AKI and 43 without. Logistic regression analysis of AKI risk factors found that RI (OR=1.139, 95%CI 1.029-1.261, P=0.012) and urine oxygen pressure (OR=0.957, 95%CI 0.923-0.991, P=0.014) at admission were independent risk factors for AKI in patients with septic shock. The sensitivity and specificity of dual RI and urine oxygen pressure in predicting AKI were 65.5% and 76.7% respectively (AUCROC 0.772, Youden index 0.423). We selected the cut-off value of RI as 0.70,and urine oxygen pressure as 48 mmHg (1 mmHg=0.133 kPa). According to this two cut-off values patients were divided into four groups, those with RI≥0.70 and urine oxygen pressure≤48 mmHg showed the highest incidence of AKI (75%). There was no statistically difference in 28-day survival rate between the four groups (P=0.197). Conclusion: High RI and low urine oxygen pressure are independent risk factors for the development of AKI in patients with septic shock. The predictive cut-off values are 0.70 for RI and 48 mmHg for urine oxygen pressure. Combination of RI and urine oxygen pressure has a practical predictive value for AKI in patients with septic shock.

[The clinical significance of microcirculation and oxygen metabolism evaluation in acute kidney injury assessment in patients with septic shock after resuscitation].

Objective: To evaluate the value of microcirculation and oxygen metabolism evaluation (MicrOME) in acute kidney injury(AKI) evaluation in patients with septic shock after resuscitation. Methods: Consecutive patients with septic shock after resuscitation and mechanical ventilation were enrolled from October 2016 to February 2017 in ICU at Peking Union Medical College Hospital.Patients were divided into 3 groups based on 10 min transcutaneous oxygen challenge test transcutaneous partial pressure of oxygen(PtcO(2))and venoarterial pressure of carbon dioxide difference (Pv-aCO(2)) /arteriovenous O(2) content difference (Ca-vO(2)) by blood gas analysis, i.e. group A [ΔPtcO(2)>66 mmHg(1 mmHg=0.133 kPa) and Pv-aCO(2)/Ca-vO(2)≤1.23], group B (ΔPtcO(2)≤66 mmHg), group C (ΔPtcO(2)>66 mmHg and Pv-aCO(2)/Ca-vO(2)>1.23). Heart rate,mean arterial pressure,central venous pressure,noradrenaline dose,lactate,Pv-aCO(2),Ca-vO(2), lactate clearance, central venous oxygen saturation(ScvO(2)) and liquid equilibrium were assessed after resuscitation.AKI staging based on Kidney Disease Global Improving Outcomes (KDIGO) clinical practice guideline was analyzed. The predictive value of lactate, ScvO(2), Pv-aCO(2)/Ca-vO(2) to progression of AKI after resuscitation was determined using receiver operating characteristic(ROC)curve analysis. Results: A total of 49 septic shock patients were enrolled including 30 males and 19 females with mean age of (61.10±17.10)years old.There were 19 patients in group A,21 patients in group B, and 9 patients in group C. Acute physiology and chronic health evaluation Ⅱ score was 20.92±7.19 and sequential organ failure assessment score 12.02±3.28. There were 4 patients with AKI and 1 progressed in group A, 11 patients with AKI and 2 progressed in group B, 6 patients with AKI and 4 progressed in group C. The cutoff value of Pv-aCO(2)/Ca-vO(2) was equal or more than 2.20 for predicting progression of AKI, resulting in a sensitivity of 85.7% and a specificity of 73.8%. Conclusion: MicrOME is a significant parameter to predict the progression of AKI in patients with septic shock after resuscitation. Pv-aCO(2)/Ca-vO(2) is also a good predictive factor.

[Effect of Salvia miltiorrhiza on serum lipid peroxide, superoxide dismutase of the patients with coronary heart disease].

Twenty-four patients of coronary heart disease(CHD) were treated with Salvia miltiorrhiza (SM) and the change of SM on serum lipid peroxide (LPO), superoxide dismutase (SOD) after treatment were observed. The results were compared with that of control group consisted of 20 healthy persons, it showed that before treatment, the serum LPO of patient was significantly higher than that of control group and the SOD of patient was lower than that of healthy subjects (P < 0.01). After treated with SM, the LPO level decreased and SOD activity increased significantly. The mechanism might be correlated with the effect of SM in inhibiting platelets aggregation, reducing blood viscosity, improving myocardial ischemia and protecting cytomembrane. It suggested that SM could be regarded as a good exogenous scavenger of oxygen free radical.