背景:急性肾损伤(AKI)是脓毒症的常见并发症。然而,脓毒症诱导的AKI的轨迹及其转录谱没有得到很好的表征.
方法:纳入2020年11月至2021年12月参加中国脓毒症多组学进展(CMAISE)中心的脓毒症患者,在第1天测量外周血单核细胞中的基因表达。在第1天和第3天通过SOFA评分(SOFARenal)的肾脏分量测量肾功能轨迹。第1天的转录谱在这些肾功能轨迹之间进行比较,并开发了支持向量机(SVM)来区分瞬态AKI和持久性AKI。
结果:研究期间共纳入172例脓毒症患者。肾功能轨迹分为四种类型:非AKI(SOFARenal=0,第1天和第3天,n=50),持续性AKI(第1天和第3天的SOFrecial>0,n=62),短暂性AKI(第1天SOFrecial>0,第3天SOFrecial=0,n=50)和AKI恶化(第1天SOFrecial=0,第3天SOFrecial>0,n=10)。持续性AKI组表现出严重的器官功能障碍和对器官支持的长期需求。恶化的AKI组在第1天显示出最少的器官功能障碍,但与非AKI和短暂性AKI组相比,血清乳酸更高,血管加压药的使用时间更长。在持续性和短暂性AKI组之间有2091个上调和1,902个下调基因(调整后的p<0.05),随着质膜复合物的富集,受体复合物,和T细胞受体复合物。利用遗传算法建立了一个43基因的SVM模型,与基于保留子集的临床变量的模型相比,显示出预测持续性AKI的性能明显更高(AUC:0.948[0.912,0.984]vs.0.739[0.648,0.830];德隆检验p<0.01)。
结论:我们的研究根据肾损伤轨迹确定了脓毒症诱导的AKI的四种亚型。表征了这些亚型的宿主反应畸变的景观。建立了基于基因标记的SVM模型来预测肾功能轨迹,并显示出比基于临床变量的模型更好的性能。未来的研究有必要验证基因模型在区分持久性和暂时性AKI方面的作用。
Acute kidney injury (AKI) is a common complication in sepsis. However, the trajectories of sepsis-induced AKI and their transcriptional profiles are not well characterized.
Sepsis patients admitted to centres participating in Chinese Multi-omics Advances In Sepsis (CMAISE) from November 2020 to December 2021 were enrolled, and gene expression in peripheral blood mononuclear cells was measured on Day 1. The renal function trajectory was measured by the renal component of the SOFA score (SOFArenal) on Days 1 and 3. Transcriptional profiles on Day 1 were compared between these renal function trajectories, and a support vector machine (SVM) was developed to distinguish transient from persistent AKI.
A total of 172 sepsis patients were enrolled during the study period. The renal function trajectory was classified into four types: non-AKI (SOFArenal = 0 on Days 1 and 3, n = 50), persistent AKI (SOFArenal > 0 on Days 1 and 3, n = 62), transient AKI (SOFArenal > 0 on Day 1 and SOFArenal = 0 on Day 3, n = 50) and worsening AKI (SOFArenal = 0 on Days 1 and SOFArenal > 0 on Day 3, n = 10). The persistent AKI group showed severe organ dysfunction and prolonged requirements for organ support. The worsening AKI group showed the least organ dysfunction on day 1 but had higher serum lactate and prolonged use of vasopressors than the non-AKI and transient AKI groups. There were 2091 upregulated and 1,902 downregulated genes (adjusted p < 0.05) between the persistent and transient AKI groups, with enrichment in the plasma membrane complex, receptor complex, and T-cell receptor complex. A 43-gene SVM model was developed using the genetic algorithm, which showed significantly greater performance predicting persistent AKI than the model based on clinical variables in a holdout subset (AUC: 0.948 [0.912, 0.984] vs. 0.739 [0.648, 0.830]; p < 0.01 for Delong\'s test).
Our study identified four subtypes of sepsis-induced AKI based on kidney injury trajectories. The landscape of host response aberrations across these subtypes was characterized. An SVM model based on a gene signature was developed to predict renal function trajectories, and showed better performance than the clinical variable-based model. Future studies are warranted to validate the gene model in distinguishing persistent from transient AKI.