Objective: To investigate the early predictive value of serum or urinary neutrophil gelatinase-associated lipocalin(NGAL), kidney injury molecule-1(KIM-1) and cystatin(CysC) for acute kidney injury(AKI) in neonates with late-onset sepsis(LOS). Methods: A total of 120 LOS neonates admitted to our hospital from October 2017 to December 2019 were retrospectively analyzed and divided into AKI group(n=23) and non-AKI group(n=97) according to modified AKIN staging system. Serum and urine samples were collected at 0, 12, 24 and 48 h after admission. The expressions of NGAL, KIM-1 and CysC in serum and urine were detected by ELISA method. The receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value of NGAL, KIM-1 and CysC in serum and urine at admission for early AKI in neonates with LOS. Multivariate Logistic regression was used to analyze the risk factors of secondary AKI in neonates with LOS. Results: Within 2 days after admission, the levels of NGAL, KIM-1 and CysC in serum and urine of AKI group were higher than those of non-AKI group(P<0.05). According to AKI staging standard, the levels of serum NGAL and urinary NGAL, KIM-1 in Grade Ⅲ group(n=4) were higher than that in Grade Ⅰ group(n=12) (P<0.05). Multivariate Logistic regression showed that urinary NGAL(OR=6.507, 95% CI 1.899-17.431), KIM-1(OR=2.304, 95% CI 1.385-5.496) and CysC(OR=1.420, 95% CI 1.097-2.641) were independent risk factors for secondary AKI in neonates with LOS(P<0.05). The area under ROC curve(AUC) of urinary NGAL was higher than that of serum NGAL(P<0.05). There was no significant difference in AUC value of KIM-1 or CysC in serum and urine samples(P>0.05). By Spearman analysis, the correlation between urinary NGAL and actual results was higher than that of serum NGAL(rs=0.588, P<0.05). In addition, by H-L goodness of fit test, serum and urinary NGAL, KIM-1, CysC had a good fit with the actual results(all P>0.05). Conclusion: Serum and urinary NGAL, KIM-1 and CysC have certain early predictive value for AKI in neonates with LOS, and urinary NGAL has the highest predictive effect.
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