S Nisula1, R Yang2, M Poukkanen3, S T Vaara4, K M Kaukonen4, M Tallgren5, M Haapio6, J Tenhunen7, A M Korhonen4, V Pettilä4. 1. Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery and sara.nisula@hus.fi. 2. Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland. 3. Department of Anaesthesia and Intensive Care Medicine, Lapland Central Hospital, Rovaniemi, Finland. 4. Intensive Care Units, Division of Anaesthesia and Intensive Care Medicine, Department of Surgery and. 5. Department of Anesthesia and Intensive Care Medicine, Turku University Hospital, Turku, Finland. 6. Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Box 340, Helsinki 00029, Finland. 7. Department of Surgical Sciences/Anaesthesiology and Intensive Care, University of Uppsala, Uppsala, Sweden.
Abstract
BACKGROUND: Interleukin-18 (IL-18) is a pro-inflammatory protein, which mediates ischaemic tubular injury, and has been suggested to be a sensitive and specific biomarker for acute kidney injury (AKI). The predictive value of IL-18 in the diagnosis, evolution, and outcome of AKI in critically ill patients is still unclear. METHODS: We measured urine IL-18 from critically ill patients at intensive care unit (ICU) admission and 24 h. We evaluated the association of IL-18 with developing new AKI, renal replacement therapy (RRT), and 90-day mortality. We calculated areas under receiver operating characteristics curves (AUCs), best cut-off values, and positive likelihood ratios (LR+) for IL-18 concerning these endpoints. Additionally, we compared the predictive value of IL-18 at ICU admission to that of urine neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: In this study population of 1439 patients the highest urine IL-18 during the first 24 h in the ICU associated with the development of AKI with an AUC [95% confidence interval (CI)] of 0.586 (0.546-0.627) and with the development of Stage 3 AKI with an AUC (95% CI) of 0.667 (0.591-0.774). IL-18 predicted the initiation of RRT with an AUC (95% CI) of 0.655 (0.572-0.739), and 90-day mortality with an AUC (95% CI) of 0.536 (0.497-0.574). CONCLUSIONS: IL-18 had poor-to-moderate ability to predict AKI, RRT, or 90-day mortality in this large cohort of critically ill patients. Thus, it should be used with caution for diagnostic or predictive purposes in the critically ill.
BACKGROUND:Interleukin-18 (IL-18) is a pro-inflammatory protein, which mediates ischaemic tubular injury, and has been suggested to be a sensitive and specific biomarker for acute kidney injury (AKI). The predictive value of IL-18 in the diagnosis, evolution, and outcome of AKI in critically ill patients is still unclear. METHODS: We measured urine IL-18 from critically ill patients at intensive care unit (ICU) admission and 24 h. We evaluated the association of IL-18 with developing new AKI, renal replacement therapy (RRT), and 90-day mortality. We calculated areas under receiver operating characteristics curves (AUCs), best cut-off values, and positive likelihood ratios (LR+) for IL-18 concerning these endpoints. Additionally, we compared the predictive value of IL-18 at ICU admission to that of urine neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: In this study population of 1439 patients the highest urine IL-18 during the first 24 h in the ICU associated with the development of AKI with an AUC [95% confidence interval (CI)] of 0.586 (0.546-0.627) and with the development of Stage 3 AKI with an AUC (95% CI) of 0.667 (0.591-0.774). IL-18 predicted the initiation of RRT with an AUC (95% CI) of 0.655 (0.572-0.739), and 90-day mortality with an AUC (95% CI) of 0.536 (0.497-0.574). CONCLUSIONS:IL-18 had poor-to-moderate ability to predict AKI, RRT, or 90-day mortality in this large cohort of critically ill patients. Thus, it should be used with caution for diagnostic or predictive purposes in the critically ill.
Authors: Khaled Ahmed; Derek Kyte; Thomas Keeley; Fabio Efficace; Jo Armes; Julia M Brown; Lynn Calman; Chris Copland; Anna Gavin; Adam Glaser; Diana M Greenfield; Anne Lanceley; Rachel Taylor; Galina Velikova; Michael Brundage; Rebecca Mercieca-Bebber; Madeleine T King; Melanie Calvert Journal: BMJ Open Date: 2016-09-21 Impact factor: 2.692
Authors: Sebastian J Klein; Anna K Brandtner; Georg F Lehner; Hanno Ulmer; Sean M Bagshaw; Christian J Wiedermann; Michael Joannidis Journal: Intensive Care Med Date: 2018-03-14 Impact factor: 17.440