scholarly journals Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2321
Author(s):  
Chang Hwan Kim ◽  
Eun Young Kim
Keyword(s):  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Kidney Injury ◽  
Sepsis Group ◽  
Surgical Intensive Care Unit ◽  
Postoperative Sepsis ◽  
Surgical Intensive Care ◽  
Cutoff Values ◽  
Stage 1 ◽  
Diagnostic And Prognostic Value

Presepsin (PSP) is a viable biomarker for the detection of bacterial infection, but it lacks accuracy when acute kidney injury (AKI) develops. Herein, we evaluated the diagnostic and prognostic value of PSP in predicting postoperative sepsis after abdominal surgery respective to the degree of AKI. A total of 311 patients who underwent abdominal surgery and were admitted to a surgical intensive care unit were enrolled and classified into non-AKI, mild-AKI (stage 1, stage 2 and stage 3 without renal replacement therapy (RRT)) and severe-AKI (stage 3 with RRT) group, according to the Kidney Disease Improving Global Outcomes criteria. In each group, PSP and other biomarkers were statistically analyzed between non-sepsis and postoperative sepsis at the admission (T0), 24 h (T1), 48 h (T2) and 72 h (T3) after surgery. In non-AKI and mild-AKI group, PSP levels were significantly higher in postoperative sepsis than non-sepsis group, whereas no difference was detected in the severe-AKI group. Cutoff values of PSP in the mild-AKI group for the prediction of postoperative sepsis were 544 pg/mL (AUC: 0.757, p < 0.001) at T0 and 458.5 pg/mL (AUC: 0.743, p < 0.001) at T1, significantly higher than in non-AKI group. In multivariate analysis, predictors of postoperative sepsis in the mild-AKI group were PSP at T2 (odds ratio (OR): 1.002, p = 0.044) and PSP at T3 (OR: 1.001, p = 0.049). PSP can be useful for predicting newly developed sepsis in patients with transient AKI after abdominal surgery with modified cutoff values.

scholarly journals Risk Factors for Acute Kidney Injury after Cardiovascular Surgery: Evidence from 2,157 Cases and 49,777 Controls - A Meta-Analysis

2016 ◽  
Vol 6 (3) ◽  
pp. 237-250 ◽  
Author(s):  
Qian Yi ◽  
Ke Li ◽  
Zhao Jian ◽  
Ying-Bin Xiao ◽  
Lin Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Cardiovascular Surgery ◽  
Nyha Class ◽  
Kidney Injury ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Renal Complication ◽  
Type Of Surgery

Purpose: Cardiovascular surgery-associated acute kidney injury (AKI-CS) contributes to mortality and morbidity. However, risk factors accelerating its development are unclear. We identified risk factors for AKI-CS in patients with cardiopulmonary bypass in the hospital surgical intensive care unit to predict and minimize renal complication in future cardiac surgery. Methods: We analyzed data from 14 case-control studies published prior to June 2014 and indexed in Science Citation Index, PubMed, and other databases to determine the major risk factors for AKI-CS. Results: Analyzed risk factors were divided into three groups: preoperative, intraoperative and postoperative. Preoperative factors included: age (OR, 4.87; 95% CI, 3.50-6.24), NYHA class III/IV (OR, 2.53; 95% CI, 1.32-4.86), hypertension (OR, 1.68; 95% CI, 1.44-1.97), preoperative creatinine (OR, 0.66; 95% CI, 0.18-1.14), peripheral vascular disease (OR, 1.31 95% CI, 1.09-1.57), respiratory system disease (OR, 1.29; 95% CI, 1.10-1.50), diabetes mellitus (OR, 1.52; 95% CI, 1.07-2.16), and cerebrovascular disease (OR, 2.13; 95% CI, 1.11-4.09). Intraoperative factors were: cardiopulmonary bypass time (OR, 33.78; 95% CI, 23.15-44.41), aortic clamping time (OR, 13.24; 95% CI, 7.78-18.69), use of intra-aortic balloon pump (OR, 4.44; 95% CI, 2.37-8.30), and type of surgery (OR, 1.01; 95% CI, 0.43-2.39). Postoperative factors were: infection (OR, 3.58; 95% CI, 1.43-8.97), redo operation (OR, 2.57; 95% CI, 1.75-3.78), emergency surgery (OR, 4.76; 95% CI, 3.05-7.43), and low cardiac output (OR, 2.30; 95% CI, 1.05-5.04). Conclusions: Our results support that preoperative, intraoperative, and postoperative factors are associated with AKI-CS. Ejection fraction, BMI, acute myocardial infarction, type of surgery, and congestive heart failure were not absolutely associated with AKI.

Usefulness of the Biomarker TIMP-2•IGFBP7 for Acute Kidney Injury Assessment in Critically Ill Patients: A Narrative Review

2021 ◽  
pp. 106002802110054
Author(s):  
Brian L. Erstad
Keyword(s):  
Acute Kidney Injury ◽  
Data Extraction ◽  
Kidney Injury ◽  
Surgical Intensive Care Unit ◽  
Limited Data ◽  
Surgical Intensive Care ◽  
Study Selection ◽  
Patients At Risk ◽  
Surgical Icu ◽  
Injury Assessment

Objectives: To review the clinical usefulness of the biomarker TIMP-2•IGFBP7 in adult, general medical-surgical intensive care unit (ICU) settings. Data Sources: PubMed (1946 to mid-February 2021) and EMBASE (1947 to mid-February 2021) with bibliographies of retrieved articles reviewed for additional articles. Study Selection and Data Extraction: Studies evaluating use of the urinary TIMP-2•IGFBP7 assay in adult patients in ICU settings. Data Synthesis: Studies published after investigations leading to TIMP-2•IGFBP7 assay approval confirm the appropriateness of considerations discussed in product labeling, such as use of the test within 12 hours of assessment, use of a dichotomous 0.3 (ng/mL)2/1000 cutoff, and use only in combination with other assessments of acute kidney injury (AKI). However, as a biomarker routinely used for early identification of patients at risk for AKI in mixed ICU populations, the additional resources required for TIMP-2•IGFBP monitoring are difficult to justify because of limited data demonstrating usefulness in preventing or ameliorating AKI and its attendant complications. Relevance to Patient Care and Clinical Practice: Biomarkers are potentially useful not only for assessment and diagnosis of AKI, but also for practitioners involved in the management of nephrotoxic medications and medications needing adjustment for decreased kidney function. Conclusions: Although there is evidence to suggest that the urinary TIMP-2•IGFBP7 biomarker is helpful in predicting AKI progression in general medical-surgical ICU patients when used within 12 hours of patient assessment in combination with routine testing, including serum creatinine and urine output, there is little evidence that its use leads to improvements in clinically important patient outcomes.

Early diagnosis of acute kidney injury

Open Medicine ◽  
2010 ◽  
Vol 5 (5) ◽  
pp. 527-534
Author(s):  
Marius Dehne ◽  
Bernd Hartmann ◽  
Christian Katzer ◽  
Rainer Röhrig
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Damage ◽  
Early Recognition ◽  
Diagnostic Testing ◽  
Kidney Injury ◽  
Laboratory Research ◽  
Surgical Intensive Care Unit ◽  
Enzyme Linked Immunosorbent Assay ◽  
Surgical Intensive Care

AbstractThere is a considerable lack of data concerning the diagnostic testing for kidney damage after surgical procedures. In this situation the most important variables should be examined with respect to their clinical informative value, the costs associated with their analysis, and their potential use in routine diagnostic testing. Forty patients in the surgical intensive care unit (ICU) with acute kidney injury (AKI) that developed during their stay of 13–18 (median, 16) days in the ICU were examined daily during their entire ICU admission. The bulk of the laboratory research consisted of the measurement of creatinine, urea, and sodium, as well as clearances rates and diuresis. Various tests for diagnosing regional renal damage (enzymes and proteins) were also carried out. The included photometry, nephelometric analysis, and ELISA (enzyme-linked immunosorbent assay). Five days before an AKI became evident, pathologic levels of urinary α1-microglobulin (tubular parameter) could already be confirmed. Serum creatinine values or creatinine clearance indicated the presence of disease only 1 day before the AKI was seen. Our results show that determination of α1-microglobulin and immunoglobulin G (glomerular parameter) levels, in addition to the level of urea in serum, be recommended for patients in surgical intensive care units who are at risk for AKI. Use of these procedures can achieve early recognition and sufficiently precise localization of renal damage.

Sign in / Sign up

Export Citation Format

Share Document