Association between procalcitonin and acute kidney injury in patients with septic shock: A case-control study

Abstract Objective This study aims to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by sepsis shock.Methods A case-control study was designed which included patients that admitted in intensive care unit (ICU) between January 2015 and October 2018. The worst values of biochemical parameters in the first 48 hours from septic shock admission to ICU were evaluated. According to KDIGO guideline, these patients were divided into AKI and non-AKI groups.Results Of 1631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients with AKI. Multiple logistic regression results showed that PCT (OR=1.017, 95% CI 1.009- 1.025, P<0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/ml, and with a sensitivity 63%, specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25mol/L and 120 mol/L (OR 0.963, 95% CI 0.929-0.999; P= 0.042). The AKI increased with the elevation of PCT when PCT was either less than 25mol/L (OR 1.077, 95% CI 1.022-1.136; P= 0.006) or more than 120mol/L (OR 1.042, 95% CI 1.009-1.076; P= 0.013). Moreover, the PCT level was significant higher in AKI group only in female patients with age under 75(P=0.001).Conclusions Our data revealed a nonlinear relationship between PCT in 48 hours admission to ICU and AKI in septic shock patients and PCT could be used as a biomarker of AKI only in female patients under 75 years with sepsis shock.