Evaluation of Procalcitonin-to-Albumin Ratio (PCT/ALB) in Predicting the Prognosis of Patients with AKI Caused by Sepsis Secondary to Bloodstream Infection

Background: To evaluate the procalcitonin/albumin (PCT/ALB) in predicting the prognosis of patients with acute kidney injury caused by sepsis secondary to bloodstream infection. Methods: The S-AKI patients aged ≥18 years who were admitted to the Intensive Care Unit (ICU) from September 2018 and September 2020 were enrolled. S-AKI was defined as primary bloodstream infection, infective endocarditis, or catheter-related bloodstream infection. The enrolled patients were divided into survival group and death group based on the diagnosis of S-AKI within 28 days. Within 48 hours after ICU admission, various biochemical, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sepsis-Related Organ Failure Assessment (SOFA) score, Glasgow Coma Scale(GCS), oxygenation index, and machine ventilation time were also recorded. Multivariate logistic regression analysis and receiver operating characteristic curve(ROC) analysis were performed to determine risk factors for 28-day prognosis in S-AKI patients and to evaluate the PCT/ALB in predicting the prognosis. Results: The APACHE II score, SOFA score, PCT/ALB ratio, PCT levels, C-reactive protein (CRP) levels, and international normalized ratio (INR) were higher in the death group compared to the survival group (P<0.05). Platelet count, total protein (TP), albumin (ALB), alanine aminotransferase (ALT), and partial pressure of carbon dioxide were lower in the death group compared to the survival group (P<0.05). Multivariate regression analysis revealed that PCT/ALB ratio, TP levels, and APACHE II score were independent factors influencing mortality in S-AKI patients(P<0.05). The area under the ROC curve for predicting 28-day mortality was 0.943 for PCT/ALB ratio with a cutoff value of 0.810; sensitivity of 0.904; and specificity of 0.906. For TP levels, it was 0.661 with a cutoff value of 0.316; sensitivity of 0.731; and specificity of 0.585. The area under the ROC curve (AUC) for predicting 28-day mortality was 0.809, with a cutoff value of 0.564, sensitivity of 0.904, and specificity of 0.660. Conclusion: PCT/ALB is an important indicator for predicting the source of primary bloodstream infection in S-AKI patients . It has certain reference value in clinical assessment.