Pietro Caironi1,2, Roberto Latini3, Joachim Struck4, Oliver Hartmann4, Andreas Bergmann4, Valentina Bellato5, Sandra Ferraris6, Gianni Tognoni7, Antonio Pesenti8, Luciano Gattinoni9, Serge Masson7. 1. Dipartimento di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S. Luigi Gonzaga, Orbassano, Italy. 2. Dipartimento di Oncologia, Università degli Studi di Torino, Turin, Italy. 3. Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy; roberto.latini@marionegri.it. 4. Sphingotec GmbH, Hennigsdorf, Germany. 5. U.O. Anestesia e Terapia Intensiva Generale, Istituto Clinico Humanitas, Rozzano, Italy. 6. U.O. di Anestesia e Rianimazione, Ospedale di Treviglio-Caravaggio, Treviglio, Italy. 7. Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy. 8. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy; Dipartimento di Anestesia, Rianimazione, ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. 9. Department of Anesthesiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany.
Abstract
BACKGROUND:Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS:Plasma proenkephalin A 119-159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS:Median [Q1-Q3] plasma penKid concentration on day 1 [84 (20-159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1-5.1; P < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7-2.8); P < 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0-5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18-0.54), P < 0.0001] and 1 week [0.23 (0.12-0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS: Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.
RCT Entities:
BACKGROUND:Acute kidney injury (AKI) occurs in many critically illpatients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS: Plasma proenkephalin A 119-159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS: Median [Q1-Q3] plasma penKid concentration on day 1 [84 (20-159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1-5.1; P < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7-2.8); P < 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0-5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18-0.54), P < 0.0001] and 1 week [0.23 (0.12-0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS: Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.
Authors: Anitha Vijayan; Emaad M Abdel-Rahman; Kathleen D Liu; Stuart L Goldstein; Anupam Agarwal; Mark D Okusa; Jorge Cerda Journal: Clin J Am Soc Nephrol Date: 2021-08-30 Impact factor: 10.614
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Authors: Toni Jäntti; Tuukka Tarvasmäki; Veli-Pekka Harjola; Kari Pulkki; Heidi Turkia; Tuija Sabell; Heli Tolppanen; Raija Jurkko; Mari Hongisto; Anu Kataja; Alessandro Sionis; Jose Silva-Cardoso; Marek Banaszewski; Salvatore DiSomma; Alexandre Mebazaa; Mikko Haapio; Johan Lassus Journal: Ann Intensive Care Date: 2021-02-05 Impact factor: 6.925