Erin K Stenson1,2, Zhiying You3, Ron Reeder4, Jesse Norris4, Halden F Scott1,5, Bradley P Dixon1,6, Joshua M Thurman3, Ashley Frazer-Abel7, Peter Mourani8, Jessica Kendrick3. 1. Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. 2. Department of Pediatrics, Section of Pediatric Critical Care, University of Colorado School of Medicine, Aurora, Colorado. 3. Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 4. Department of Pediatrics, University of Utah, Salt Lake City, Utah. 5. Department of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado. 6. Department of Pediatrics, Section of Pediatric Nephrology, University of Colorado School of Medicine, Aurora, Colorado. 7. Department of Pediatrics, Exsera BioLabs, University of Colorado Anschutz Medical Campus, Aurora, Colorado. 8. Division of Critical Care Medicine, Arkansas Children's Hospital, Little Rock, Arkansas.
Abstract
Background: Children who are critically ill with AKI suffer from high morbidity and mortality rates, and lack treatment options. Emerging evidence implicates the role of complement activation in AKI pathogenesis, which could potentially be treated with complement inhibitors. The purpose of this study is to evaluate the association between complement activation fragments and severity of AKI in children who are critically ill. Methods: A biorepository of samples from children who are critically ill from a prior multisite study was leveraged to identify children with stage 3 AKI and matched to patients without AKI on the basis of PELOD-2 (illness severity) scores. Specimens were analyzed for plasma and urine complement activation fragments of factor B, C3a, C4a, and sC5b-9. The primary outcomes were MAKE30 and severe AKI rates. Results: In total, 14 patients with stage 3 AKI (five requiring RRT) were matched to 14 patients without AKI. Urine factor Ba and plasma C4a levels increased stepwise as severity of AKI increased, from no AKI to stage 3 AKI, to stage 3 AKI with RRT need. Plasma C4a levels were independently associated with increased risk of MAKE30 outcomes (OR, 3.2; IQR, 1.1-8.9), and urine Ba (OR, 1.9; IQR, 1.1-3.1), plasma Bb (OR, 2.7; IQR, 1.1-6.8), C4a (OR, 13.0; IQR, 1.6-106.6), and C3a (OR, 3.3; IQR, 1.3-8.4) were independently associated with risk of severe stage 2-3 AKI on day 3 of admission. Conclusions: Multiple complement fragments increase as magnitude of AKI severity increases. Very high levels of urine Ba or plasma C4a may identify patients at risk for severe AKI, hemodialysis, and MAKE30 outcomes. The fragments may be useful as a functional biomarker of complement activation and may identify those patients to study complement inhibition to treat or prevent AKI in children who are critically ill. These findings suggest the need for further specific investigations of the role of complement activation in children who are critically ill and at risk of AKI.
Background: Children who are critically ill with AKI suffer from high morbidity and mortality rates, and lack treatment options. Emerging evidence implicates the role of complement activation in AKI pathogenesis, which could potentially be treated with complement inhibitors. The purpose of this study is to evaluate the association between complement activation fragments and severity of AKI in children who are critically ill. Methods: A biorepository of samples from children who are critically ill from a prior multisite study was leveraged to identify children with stage 3 AKI and matched to patients without AKI on the basis of PELOD-2 (illness severity) scores. Specimens were analyzed for plasma and urine complement activation fragments of factor B, C3a, C4a, and sC5b-9. The primary outcomes were MAKE30 and severe AKI rates. Results: In total, 14 patients with stage 3 AKI (five requiring RRT) were matched to 14 patients without AKI. Urine factor Ba and plasma C4a levels increased stepwise as severity of AKI increased, from no AKI to stage 3 AKI, to stage 3 AKI with RRT need. Plasma C4a levels were independently associated with increased risk of MAKE30 outcomes (OR, 3.2; IQR, 1.1-8.9), and urine Ba (OR, 1.9; IQR, 1.1-3.1), plasma Bb (OR, 2.7; IQR, 1.1-6.8), C4a (OR, 13.0; IQR, 1.6-106.6), and C3a (OR, 3.3; IQR, 1.3-8.4) were independently associated with risk of severe stage 2-3 AKI on day 3 of admission. Conclusions: Multiple complement fragments increase as magnitude of AKI severity increases. Very high levels of urine Ba or plasma C4a may identify patients at risk for severe AKI, hemodialysis, and MAKE30 outcomes. The fragments may be useful as a functional biomarker of complement activation and may identify those patients to study complement inhibition to treat or prevent AKI in children who are critically ill. These findings suggest the need for further specific investigations of the role of complement activation in children who are critically ill and at risk of AKI.
Authors: T Yamamoto; Y Watarai; K Futamura; M Okada; M Tsujita; T Hiramitsu; N Goto; S Narumi; A Takeda; T Kobayashi Journal: Transplant Proc Date: 2017 Jan - Feb Impact factor: 1.066
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Authors: Eva Rodríguez; Javier Gimeno; Carlos Arias-Cabrales; Clara Barrios; Dolores Redondo-Pachón; María José Soler; Marta Crespo; Adriana Sierra-Ochoa; Marta Riera; Julio Pascual Journal: Kidney Blood Press Res Date: 2018-10-31 Impact factor: 2.687