scholarly journals Potential Value of TNF-α (–376 G/A) Polymorphism and Cystatin C (CysC) in the Diagnosis of Sepsis Associated Acute Kidney Injury (S-AK I) and Prediction of Mortality in Critically Ill patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Hiba S Al-Amodi ◽  
Shimaa Abdelsattar ◽  
Zeinab A. Kasemy ◽  
Hanan M. Bedair ◽  
Hany S. Elbarbary ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Health Concern ◽  
Enzyme Linked Immunosorbent Assay ◽  
Potential Value ◽  
Prediction Of Mortality ◽  
Tnf Α ◽  
Significant Difference

Sepsis Associated Kidney Injury represents a major health concern as it is frequently associated with increased risk of mortality and morbidity. We aimed to evaluate the potential value of TNF-α (−376 G/A) and cystatin C in the diagnosis of S-AKI and prediction of mortality in critically ill patients. This study included 200 critically ill patients and 200 healthy controls. Patients were categorized into 116 with acute septic shock and 84 with sepsis, from which 142 (71%) developed S-AKI. Genotyping of TNF-α (−376 G/A) was performed by RT-PCR and serum CysC was assessed by Enzyme Linked Immunosorbent Assay. Our results showed a highly significant difference in the genotype frequencies of TNF-α (−376 G/A) SNP between S-AKI and non-AKI patients (p < 0.001). Additionally, sCysC levels were significantly higher in the S-AKI group (p = 0.011). The combination of both sCysC and TNF-α (−376 G/A) together had a better diagnostic ability for S-AKI than sCysC alone (AUC = 0.610, 0.838, respectively). Both GA and AA genotypes were independent predictors of S-AKI (p= < 0.001, p = 0.002 respectively). Additionally, sCysC was significantly associated with the risk of S-AKI development (Odds Ratio = 1.111). Both genotypes and sCysC were significant predictors of non-survival (p < 0.001), suggesting their potential role in the diagnosis of S-AKI and prediction of mortality.

Urinary biomarkers predict progression and adverse outcomes ofacute kidney injury in critical illness

2021 ◽  
Author(s):  
Stephen Duff ◽  
Ruairi Irwin ◽  
Jean Maxime Cote ◽  
Lynn Redahan ◽  
Blaithin A McMahon ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Urinary Biomarkers ◽  
High Morbidity ◽  
Diagnostic Analysis ◽  
Prognostic Analysis ◽  
Stage 1

Abstract Background Acute Kidney Injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective cohort study of critically ill patients (n = 717). We hypothesised that novel urinary biomarkers would predict progression of AKI and associated outcomes. Methods The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or2 AKI to predict progression to higher AKI Stage, RRT or Death within 7 days of ICU admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or Death within 30 days. Results In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, eight of the 14 biomarkers were independently associated with progression. The best predictors were Cystatin C (aOR 5.2; 95% CI, 1.3-23.6), IL-18 (aOR 5.1; 95% CI, 1.8-15.7), Albumin (aOR 4.9; 95% CI, 1.5-18.3) and NGAL (aOR 4.6; 95% CI, 1.4-17.9). ROC and Net Reclassification Index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stage 1-3 AKI cases, IL-18, NGAL, Albumin, and MCP-1 were also independently associated with RRT or Death within 30 days. Conclusions Among 14 novel urinary biomarkers assessed, Cystatin C, IL-18, Albumin and NGAL were the best predictors of Stage 1-2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.

scholarly journals New Biomarkers for the Quick Detection of Acute Kidney Injury

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Abdulmuttalip Simsek ◽  
Volkan Tugcu ◽  
Ali Ihsan Tasci
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Clinical Training ◽  
Kidney Injury ◽  
Urinary Proteins ◽  
New Biomarkers ◽  
Urine And Serum

Acute kidney injury (AKI) is a common and strong problem in the diagnosis of which based on measurement of BUN and serum creatinine. These traditional methods are not sensitive and specific for the diagnosis of AKI. AKI is associated with increased morbidity and mortality in critically ill patients and a quick detection is impossible with BUN and serum creatinine. A number of serum and urinary proteins have been identified that may messenger AKI prior to a rise in BUN and serum creatinine. New biomarkers of AKI, including NGAL, KIM-1, cystatin-C, IL-18, and L-FABP, are more favourable tests than creatinine which have been identified and studied in several experimental and clinical training. This paper will discuss some of these new biomarkers and their potential as useful signs of AKI. We searched the literature using PubMed and MEDLINE with acute kidney injury, urine, and serum new biomarkers and the articles were selected only from publication types in English.

scholarly journals Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Yukari Aoyagi ◽  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
Masanori Takinami ◽  
Shoichi Uezono
Keyword(s):  
Blood Glucose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Control ◽  
Blood Glucose Control ◽  
Kidney Injury ◽  
Saline Group ◽  
Significant Difference ◽  
The Impact ◽  
Electrolyte Abnormalities

Abstract Background The choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. However, there has been little research on drug diluents in this context. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality. Methods This before-after, two-group comparative, retrospective study enrolled adult patients who stayed for more than 48 h in a general intensive care unit from July 2015 to December 2018. We changed the default diluent for intermittent drug sets in our electronic ordering system from D5W to saline at the end of 2016. Results We included 844 patients: 365 in the D5W period and 479 in the saline period. Drug diluents accounted for 21.4% of the total infusion volume. The incidences of hypernatremia and hyperchloremia were significantly greater in the saline group compared to the D5W group (hypernatremia 27.3% vs. 14.6%, p < 0.001; hyperchloremia 36.9 % vs. 20.4%, p < 0.001). Multivariate analyses confirmed the similar effects (hypernatremia adjusted odds ratio (OR), 2.43; 95% confidence interval (CI), 1.54–3.82; hyperchloremia adjusted OR, 2.09; 95% CI, 1.31–3.34). There was no significant difference in the incidences of hyperglycemia, AKI, and mortality between the two groups. Conclusions Changing the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia.

scholarly journals Higher Plasma Cystatin C is associated with Mortality after Acute Respiratory Distress Syndrome: Findings from a Fluid and Catheter Treatment Trial (FACTT) Substudy

2020 ◽  
Author(s):  
Carolyn M. Hendrickson ◽  
Yuenting Diana Kwong ◽  
Annika G Belzer ◽  
Michael G Shlipak ◽  
Michael A Matthay ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Kidney Disease ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Treatment Trial

Abstract Background: Cystatin C is a well validated marker of glomerular filtration rate in chronic kidney disease. Higher plasma concentrations of cystatin C are associated with worse clinical outcomes in heterogenous populations of critically-ill patients and may be superior to creatinine in identifying kidney injury in critically-ill patients. We hypothesized that elevated levels of plasma cystatin C in patients with Acute Respiratory Distress Syndrome (ARDS) would be associated with mortality risk. Methods: In a retrospective study, cystatin C was measured by nephelometry on plasma obtained at enrollment from 919 patients in the Fluid and Catheter Treatment Trial. Multivariable logistic regression was performed testing the association between quartiles of cystatin C and 60-day mortality. Analyses were stratified by Acute kidney injury (AKI) status identified in the first 7 days after enrollment by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: Cystatin C was significantly higher among those patients who died compared to those who survived to 60 days [1.2 (0.9 – 1.9) mg/L vs. 0.8 (0.6 – 1.2) mg/L, p <0.001]. Compared to the lower three quartiles, subjects in the highest quartile of cystatin C had a significantly higher odds of death at 60 days [OR 1.8 (1.2-2.6), p=0.003 in adjusted analyses]; the odds of death incrementally rose in higher cystatin C quartiles compared to the lowest quartile (OR 1.1, 1.8, and 2.5). In adjusted analyses stratified by AKI status, compared to subjects in the lower three quartiles, subjects in the highest quartile of cystatin C with AKI had a significantly higher odds of death at 60 days both in participants with AKI [OR 1.6 (1.0-2.4), p=0.048] and those without AKI [OR 2.4 (1.2-5.0), p=0.017]. In adjusted analyses, there was no significant association between sex-stratified baseline creatinine quartiles and mortality. Conclusions: Higher plasma levels of cystatin C on enrollment were strongly associated with mortality at 60-days in patients with ARDS with and without AKI identified by creatinine-based definitions. Compared to creatinine, cystatin C may be a better biomarker of kidney function in patients with ARDS and therefore identify patients with multiple organ failure at higher risk of death.

The impact of fluid balance on diagnosis, staging and prediction of mortality in critically ill patients with acute kidney injury

2015 ◽  
Vol 29 (2) ◽  
pp. 221-227 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Narat Srivali ◽  
Patompong Ungprasert ◽  
Wonngarm Kittanamongkolchai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Prediction Of Mortality ◽  
The Impact

scholarly journals Effect of Dexmedetomidine on Intestinal Barrier in Patients Undergoing Gastrointestinal Surgery - A Single-Centre Randomized Clinical Trial

2021 ◽  
Author(s):  
Yupeng Qi ◽  
Wenjing Ma ◽  
Yingya Cao ◽  
Qun Chen ◽  
Qiancheng Xu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Gastrointestinal Surgery ◽  
Intestinal Barrier ◽  
Intestinal Barrier Function ◽  
Apache Ii Score ◽  
Tnf Α ◽  
Significant Difference ◽  
Gastrointestinal Failure ◽  
The Mean

Abstract Background: Gastrointestinal failure accounts for death in critically ill patients. This study aimed to explore the effect and mechanism of dexmedetomidine (DEX) in intestinal barrier function in critically ill patients undergoing gastrointestinal surgery.Methods: Patients undergoing gastrointestinal surgery were randomized into a DEX group (n=21) or an MID group (n=21). Sufentanil was used in both groups for analgesia. In the DEX group, DEX was loaded (1 µg/kg) before sedation and was infused (0.7 µg/kg/h) during sedation. The mean arterial pressure (MAP), heart rate (HR), borborygmus resumption time (BRT), first defecation time (FDT), stay of ICU and hospital were observed. The DAO, D-LAC, TNF-α, IL-6 and α7nAChR levels in plasma or haemocytes were detected before the start of the sedation (0 h) and after the sedation (24 h).Results: There were no significant differences in age, sex, BMI, APACHE II score, SOFA (P>0.05). The MAP between 0 and 24 h presented no significant difference between the groups (P > 0.05), but HR was significantly slower in the DEX group (P=0.042). The recovery time of bowel sounds was significantly earlier in the DEX group (P=0.034). Both of the stay of ICU (P=0.016) and hospital (P=0.031) were significantly shorter in the DEX group. The expression of α7nAChR in the DEX group was significantly higher at 24 h than at 0 h (P=0.002). The D-LAC decreased significantly in the DEX group than MID group at 24 h (P=0.016).Conclusions: DEX maintained the integrity of the intestinal barrier in patients undergoing gastrointestinal surgery through the cholinergic anti-inflammatory pathway.Trial registration:ChiCTR1900024367. Registered 7 July 2019-Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=40832

URINARY LIVER TYPE FATTY ACID BINDING PROTIEN AND PLASMA CYSTATIN C PREDICT ACUTE KIDNEY INJURY OUTCOMES IN CRITICALLY ILL PATIENTS

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Mohammed Attia El-Farahati ◽  
Essam Harash ◽  
Alsayed Alnahal ◽  
Mohamed Fouad ◽  
Medhat Ibrahim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Fatty Acid ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Fatty Acid Binding ◽  
Injury Outcomes

scholarly journals IP-10 and MCP-1 as biomarkers associated with disease severity of COVID-19

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Yu Chen ◽  
Jinglan Wang ◽  
Chenxi Liu ◽  
Longxiang Su ◽  
Dong Zhang ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Symptoms ◽  
Enzyme Linked Immunosorbent Assay ◽  
Monocyte Chemoattractant Protein 1 ◽  
Risk Of Death ◽  
Inflammatory Protein ◽  
Laboratory Test Results ◽  
Significant Difference ◽  
Inducible Protein

Abstract Background COVID-19 is a viral respiratory disease caused by the severe acute respiratory syndrome-Coronavirus type 2 (SARS-CoV-2). Patients with this disease may be more prone to venous or arterial thrombosis because of the activation of many factors involved in it, including inflammation, platelet activation and endothelial dysfunction. Interferon gamma inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein 1-alpha (MIP1α) are cytokines related to thrombosis. Therefore, this study focused on these three indicators in COVID-19, with the hope to find biomarkers that are associated with patients’ outcome. Methods This is a retrospective single-center study involving 74 severe and critically ill COVID-19 patients recruited from the ICU department of the Tongji Hospital in Wuhan, China. The patients were divided into two groups: severe patients and critically ill patients. The serum IP-10, MCP-1 and MIP1α level in both groups was detected using the enzyme-linked immunosorbent assay (ELISA) kit. The clinical symptoms, laboratory test results, and the outcome of COVID-19 patients were retrospectively analyzed. Results The serum IP-10 and MCP-1 level in critically ill patients was significantly higher than that in severe patients (P < 0.001). However, no statistical difference in MIP1α between the two groups was found. The analysis of dynamic changes showed that these indicators remarkably increased in patients with poor prognosis. Since the selected patients were severe or critically ill, no significant difference was observed between survival and death. Conclusions IP-10 and MCP-1 are biomarkers associated with the severity of COVID-19 disease and can be related to the risk of death in COVID-19 patients.

scholarly journals Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0003552020
Author(s):  
Alexander H. Flannery ◽  
Katherine Bosler ◽  
Victor M. Ortiz-Soriano ◽  
Fabiola Gianella ◽  
Victor Prado ◽  
...  
Keyword(s):  
Prediction Model ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Clinical Prediction ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Clinical Prediction Model ◽  
Major Adverse Kidney Events

Background: Several biomarkers of acute kidney injury (AKI) have been examined for their ability to predict AKI before serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research. Methods: Single-center prospective study collecting blood and urine samples from critically ill patients with AKI Kidney Disease: Improving Global Outcomes stage 2 or above, and matched controls from a single, tertiary care intensive care unit. Samples were collected at 24-48 hours after AKI diagnosis (cases) or ICU admission (controls), 5-7 days later, and 4-6 weeks following discharge for AKI patients. The primary outcome of interest was MAKE at hospital discharge (MAKE-DC), consisting of the composite endpoint of death, renal replacement therapy dependence, or a decrease in estimated glomerular filtration to <75% of baseline. Results: Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE-DC compared to those not experiencing MAKE-DC. Additionally, serum/urinary NGAL and serum cystatin C measurements at the first time point remained significantly associated with MAKE events at 3, 6, and 12 months. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a logistic regression clinical prediction model of MAKE-DC (AUROC 0.94 and 0.87 vs. 0.83; p= 0.001 and 0.019, respectively). Patients without MAKE-DC experienced a greater decline in serum NGAL from first to second measurement than those patients experiencing MAKE-DC. Conclusion: Early measures of kidney biomarkers in critically ill patients are associated with MAKE-DC. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE-DC.

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