Endothelial Activation and Stress Index Elevation Associated with Adverse Prognosis in Sepsis-Associated Acute Kidney Injury Patients: Validation Based on Two Critical Care Cohorts

作者：Zhiyuan Zhang, Chaowei Wang, Jiangui Wang, Zixin Luo, Kang Zou, Qinglin Xu · 发表于：Shock · 年份：2025 · DOI：10.1097/shk.0000000000002715 · 被引用次数：5 · 研究领域：Acute Kidney Injury Research、Sepsis Diagnosis and Treatment、Inflammation biomarkers and pathways

BACKGROUND: Sepsis-associated acute kidney injury (SA-AKI) is a prevalent complication in critical care settings with high mortality. The role of the Endothelial Activation Stress Index (EASIX) in SA-AKI has not yet been evaluated. METHODS: In this retrospective cohort study, data from 12,267 SA-AKI patients in Medical Information Mart for Intensive Care IV were analyzed. EASIX was categorized using curve fitting and inflection point analysis. Propensity score matching (PSM) ensured data balance. Cox models, Kaplan-Meier analysis, subgroup analyses, and receiver operating characteristic curves assessments were used to examine the association between EASIX and outcomes. Furthermore, we validated these findings using the eICU Collaborative Research Database. RESULTS: A non-linear association between EASIX and 28-day mortality was found, with an inflection point at 10.83. PSM balanced covariates. Kaplan-Meier analysis showed significantly lower survival in the high EASIX group ( P < 0.001 pre-PSM, P = 0.002 post-PSM). Post-PSM, the high EASIX group had higher 28-day mortality (42.9% vs. 32.9%), in-hospital mortality (40.5% vs. 30.8%), and intensive care unit mortality (29.6% vs. 20.4%; all P < 0.001). Multivariable regression and weighting methods confirmed the increased mortality risk. Subgroup analyses further validated these findings. Receiver operating characteristic analysis yielded an area under the curve for 28-day mortality, outperforming sequential organ failure assessm...