The value of combined use of laboratory indicators for diagnosis of early renal functional damage
10.3969/j.issn.1008-9691.2014.04.015
- VernacularTitle:肾功能早期损伤诊断指标联合应用的价值
- Author:
Haiying HUANG
;
Bo CHEN
;
Qiang ZHOU
;
Hongyun JIA
;
Tianxing JI
- Publication Type:Journal Article
- Keywords:
Renal function injury;
Combination diagnosis;
Cystatin C;
Creatinine;
Urea;
Creatinine clearance rate;
Glomerular filtration rate;
Receiver operating characteristic curve;
Optimal critical value
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2014;(4):298-302
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the value of combined use of laboratory indicators for diagnosis of early renal functional damage. Methods Eighty-six patients with various kidney diseases were enrolled in the Second Affiliated Hospital of Guangzhou Medical University. On admission,the serum Cystatin C(Cys C),creatinine(Cr), Urea,etc were determined. The value of using combined laboratory indicators in the diagnosis of renal functional damage was obtained through the analysis of the receiver operating characteristic curve(ROC curve);multiple variable indicators were grouped to establish multiple logistic regression models to be compared and evaluated. Results In the early and late renal injury groups(group B of 32 cases and group C of 12 cases),the serum levels of Cys C,Cr, and Urea were significantly higher than those in the normal renal function control group(group A of 42 cases),the elevation in level in group C being the most significant〔Cys C(mg/L):3.47±0.75 vs. 1.59±1.29,Cr(μmol/L):669±466 vs. 214±173,Urea(mmol/L):21.22±13.10 vs. 11.04±8.24,P<0.05 or P<0.01〕. The areas under the ROC curve(AUC)made by combinations of Cys C,Cr and Urea for the diagnosis of renal damage were 0.908,0.817 and 0.785. In the four different kinds of combination of the indicators,the AUC were sequentially arranged from large to small area as follows:Cys C+Cr+Urea=Cys C+Cr>Cys C+Urea>Cys C>Cr+Urea(0.920=0.920>0.911>0.908>0.809). In this sequence,the AUC made by Cys C+Cr+Urea and Cys C+Cr were equal,both 0.920, whose sensitivity was 75.0%,specificity 100.0%,positive predictive value 100.0%,negative predictive value 80.0%and diagnostic accuracy rate 87.5%. So,Cys C + Cr combination could be used to substitute Cys C + Cr + Urea, and the former clinical diagnostic effect was the best,much higher than that by using AUC whose curve was made by Cys C alone. Conclusion The value of using only one laboratory indicator for diagnosis of patients with early renal functional damage is not high,while applying Cys C+Cr combination can improve the diagnostic effect greatly,and its sensitivity and specificity are higher.
