RRI IVC-RVI联合血清Sirtuin3 mRNA对脓毒性休克继发急性肾损伤的早期预警效能及意义

doi:10.3969/j.issn.1006-6233.2025.05.020

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Abstract Objective: To investigate the early warning efficacy and significance of renal resistance index (RRI), inferior vena cava respiratory variability index (IVC-RVI), and serum silent information regulator 3 (Sirtuin3 mRNA) in predicting acute kidney injury (AKI) secondary to septic shock. Methods: A total of 185 patients with septic shock admitted to our hospital from August 2020 to August 2023 were enrolled and divided into an AKI group (90 cases) and a non-AKI group (95 cases) based on whether AKI developed. Baseline data, RRI, IVC-RVI, and serum Sirtuin3 mRNA levels at 0 hours and 24 hours after fluid resuscitation were compared between the two groups. Multivariate logistic regression was used to analyze the effects of RRI reduction rate, IVC-RVI reduction rate, and serum Sirtuin3 mRNA on AKI secondary to septic shock. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of different models for AKI secondary to septic shock. Results: The APACHE II score and SOFA score in the AKI group were significantly higher than those in the non-AKI group (P<0.05). The RRI at 0h and 24h of fluid resuscitation in the AKI group was higher than that in the non-AKI group, and the decrease rate of RRI and Sirtuin3 mRNA were lower than those in the non-AKI group (P<0.05). The IVC-RVI at 0h and 24h of fluid resuscitation in the AKI group was lower than that in the non-AKI group, and the decrease rate of IVC-RVI was higher than that in the non-AKI group (P<0.05). Multivariate analysis showed that the reduction rate of RRI, the reduction rate of IVC-RVI, and Sirtuin3 mRNA were all independent factors associated with AKI secondary to septic shock. Each unit increase in these three factors increased the risk of AKI by 0.402, 1.365, and 0.398 times, respectively (P<0.05). ROC analysis showed that the AUC of traditional schemes: APACHE II score and SOFA score for predicting AKI secondary to septic shock were 0.729 and 0.744, respectively (P<0.001). New scheme: The AUC of RRI reduction rate, IVC-RVI reduction rate, Sirtuin3 mRNA, and the combination of the three for predicting AKI secondary to septic shock were 0.758, 0.766, 0.773, and 0.921, respectively (P<0.001). The RRI reduction rate + IVC-RVI reduction rate + AUC of Sirtuin3 mRNA were significantly greater than the APACHE II score, SOFA score, RRI reduction rate, IVC-RVI reduction rate, and Sirtuin3 mRNA (P<0.05). Sensitivity analysis showed that compared with the combination, the AUC values of Apache Ⅱ score+combination, SOFA score+combination, Apache Ⅱ score+SOFA score+combination were not significantly improved (P>0.05), suggesting that the prediction scheme including Apache Ⅱ score and SOFA score would not increase the prediction value, and had no significant impact on the joint prediction results after elimination. Conclusion: The reduction rate of RRI, IVC-RVI, and serum Sirtuin3 mRNA after 24 hours of fluid resuscitation are closely related to the occurrence of AKI secondary to septic shock. The combination of the three can provide early warning of the risk of AKI, and has higher predictive value than the traditional APACHE II score and SOFA score, providing a reference for clinical early warning of AKI and reducing the occurrence of AKI.

Key words： Renal resistance index Inferior vena cava respiratory variability index Sirtuin3 mRNA Septic shock Acute kidney injury Early warning efficacy

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	FENG Ning
	PAN Lu
	GUO Kun
	et al

Cite this article:

FENG Ning,PAN Lu,GUO Kun, et al. Early Warning Efficacy and Significance of Renal Resistance Index (RRI) Inferior Vena Cava Respiratory Variability Index (IVC-RVI) Combined with Serum Sirtuin3 mRNA for Acute Kidney Injury Secondary to Septic Shock[J]. HeBei Med, 2025, 31(5): 816-823.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2025.05.020 OR http://www.hbyxzzs.cn/EN/Y2025/V31/I5/816

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