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Neu C, Beckers C, Frank N, Thomas K, Bartneck M, Simon TP, Mossanen J, Peters K, Singendonk T, Martin L, Marx G, Kraemer S, Zechendorf E. Ribonuclease inhibitor 1 emerges as a potential biomarker and modulates inflammation and iron homeostasis in sepsis. Sci Rep 2024; 14:14972. [PMID: 38951571 PMCID: PMC11217267 DOI: 10.1038/s41598-024-65778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Sepsis, marked by organ dysfunction, necessitates reliable biomarkers. Ribonuclease inhibitor 1 (RNH1), a ribonuclease (RNase) inhibitor, emerged as a potential biomarker for acute kidney injury and mortality in thoracoabdominal aortic aneurysm patients. Our study investigates RNH1 dynamics in sepsis, its links to mortality and organ dysfunction, and the interplay with RNase 1 and RNase 5. Furthermore, we explore RNH1 as a therapeutic target in sepsis-related processes like inflammation, non-canonical inflammasome activation, and iron homeostasis. We showed that RNH1 levels are significantly higher in deceased patients compared to sepsis survivors and correlate with creatine kinase, aspartate and alanine transaminase, bilirubin, serum creatinine and RNase 5, but not RNase 1. RNH1 mitigated LPS-induced TNFα and RNase 5 secretion, and relative mRNA expression of ferroptosis-associated genes HMOX1, FTH1 and HAMP in PBMCs. Monocytes were identified as the predominant type of LPS-positive PBMCs. Exogenous RNH1 attenuated LPS-induced CASP5 expression, while increasing IL-1β secretion in PBMCs and THP-1 macrophages. As RNH1 has contradictory effects on inflammation and non-canonical inflammasome activation, its use as a therapeutic agent is limited. However, RNH1 levels may play a central role in iron homeostasis during sepsis, supporting our clinical observations. Hence, RNH1 shows promise as biomarkers for renal and hepatic dysfunction and hepatocyte injury, and may be useful in predicting the outcome of septic patients.
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Affiliation(s)
- Carolina Neu
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Beckers
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nadine Frank
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Katharina Thomas
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matthias Bartneck
- Department of Medicine III, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Tim-Philipp Simon
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jana Mossanen
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Kimmo Peters
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Tobias Singendonk
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Lukas Martin
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gernot Marx
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sandra Kraemer
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Elisabeth Zechendorf
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Dong Y, Liu G, Situ X, Xia L, Zhang T, Zhu X, Jin H, Liu Y, Shou S. Non-Canonical STING-PERK Pathway Modulation of Cellular Senescence and Therapeutic Response in Sepsis-Associated Acute Kidney Injury. Inflammation 2024:10.1007/s10753-024-02081-8. [PMID: 38913144 DOI: 10.1007/s10753-024-02081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
Abstract-This study explored the role of the non-canonical STING-PERK signaling pathway in sepsis-associated acute kidney injury (SA-AKI). Gene expression data from the GEO database and serum STING protein levels in patients with SA-AKI were analyzed. An LPS-induced mouse model and an in vitro model using HK-2 cells were used to investigate the role of STING in SA-AKI. STING expression was suppressed using shRNA silencing technology and the STING inhibitor C176. Kidney function, inflammatory markers, apoptosis, and senescence were measured. The role of the STING-PERK pathway was investigated by silencing PERK in HK-2 cells and administering the PERK inhibitor GSK2606414. STING mRNA expression and serum STING protein levels were significantly higher in patients with SA-AKI. Suppressing STING expression improved kidney function, reduced inflammation, and inhibited apoptosis and senescence. Silencing PERK or administering GSK2606414 suppressed the inflammatory response, cell apoptosis, and senescence, suggesting that PERK is a downstream effector in the STING signaling pathway. The STING-PERK signaling pathway exacerbates cell senescence and apoptosis in SA-AKI. Inhibiting this pathway could provide potential therapeutic targets for SA-AKI treatment.
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Affiliation(s)
- Yuxin Dong
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Guanghe Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xiaonan Situ
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Lei Xia
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Tianyi Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xiangxi Zhu
- Zunyi Medical University, No. 368 Jinwan Road, Jinhaian Community, Sanzao Town, Jinwan District, Zhuhai, 519041, Guangdong, China
| | - Heng Jin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.
| | - Yancun Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.
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Lai CF, Liu JH, Tseng LJ, Tsao CH, Chou NK, Lin SL, Chen YM, Wu VC. Unsupervised clustering identifies sub-phenotypes and reveals novel outcome predictors in patients with dialysis-requiring sepsis-associated acute kidney injury. Ann Med 2023; 55:2197290. [PMID: 37043222 PMCID: PMC10101673 DOI: 10.1080/07853890.2023.2197290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/25/2023] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Heterogeneity exists in sepsis-associated acute kidney injury (SA-AKI). This study aimed to perform unsupervised consensus clustering in critically ill patients with dialysis-requiring SA-AKI. PATIENTS AND METHODS This prospective observational cohort study included all septic patients, defined by the Sepsis-3 criteria, with dialysis-requiring SA-AKI in surgical intensive care units in Taiwan between 2009 and 2018. We employed unsupervised consensus clustering based on 23 clinical variables upon initializing renal replacement therapy. Multivariate-adjusted Cox regression models and Fine-Gray sub-distribution hazard models were built to test associations between cluster memberships with mortality and being free of dialysis at 90 days after hospital discharge, respectively. RESULTS Consensus clustering among 999 enrolled patients identified three sub-phenotypes characterized with distinct clinical manifestations upon renal replacement therapy initiation (n = 352, 396 and 251 in cluster 1, 2 and 3, respectively). They were followed for a median of 48 (interquartile range 9.5-128.5) days. Phenotypic cluster 1, featured by younger age, lower Charlson Comorbidity Index, higher baseline estimated glomerular filtration rate but with higher severity of acute illness was associated with an increased risk of death (adjusted hazard ratio of 3.05 [95% CI, 2.35-3.97]) and less probability to become free of dialysis (adjusted sub-distribution hazard ratio of 0.55 [95% CI, 0.38-0.8]) than cluster 3. By examining distinct features of the sub-phenotypes, we discovered that pre-dialysis hyperlactatemia ≥3.3 mmol/L was an independent outcome predictor. A clinical model developed to determine high-risk sub-phenotype 1 in this cohort (C-static 0.99) can identify a sub-phenotype with high in-hospital mortality risk (adjusted hazard ratio of 1.48 [95% CI, 1.25-1.74]) in another independent multi-centre SA-AKI cohort. CONCLUSIONS Our data-driven approach suggests sub-phenotypes with clinical relevance in dialysis-requiring SA-AKI and serves an outcome predictor. This strategy represents further development toward precision medicine in the definition of high-risk sub-phenotype in patients with SA-AKI.Key messagesUnsupervised consensus clustering can identify sub-phenotypes of patients with SA-AKI and provide a risk prediction.Examining the features of patient heterogeneity contributes to the discovery of serum lactate levels ≥ 3.3 mmol/L upon initializing RRT as an independent outcome predictor.This data-driven approach can be useful for prognostication and lead to a better understanding of therapeutic strategies in heterogeneous clinical syndromes.
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Affiliation(s)
- Chun-Fu Lai
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jung-Hua Liu
- Department of Communication, National Chung Cheng University, Minhsiung, Taiwan
| | - Li-Jung Tseng
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chun-Hao Tsao
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Nai-Kuan Chou
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shuei-Liong Lin
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yung-Ming Chen
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- National Taiwan University Hospital Bei-Hu Branch, Taipei City, Taiwan
| | - Vin-Cent Wu
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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Rehan ST, Hussain HU, Ali E, Kumar KA, Tabassum S, Hasanain M, Shaikh A, Ali G, Yousaf Z, Asghar MS. Role of soluble urokinase type plasminogen activator receptor (suPAR) in predicting mortality, readmission, length of stay and discharge in emergency patients: A systematic review and meta analysis. Medicine (Baltimore) 2023; 102:e35718. [PMID: 37960735 PMCID: PMC10637562 DOI: 10.1097/md.0000000000035718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/28/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker that is used to predict mortality, readmission, early discharge, and LOS, thus, serves as a useful tool for ED physicians. Our study aims to analyze the efficacy of suPAR in predicting these prognostic markers in ED. METHODS We performed a comprehensive search on 6 databases from the inception to 30th November 2022, to select the following eligibility criteria; a) observation or triage trial studies investigating the role of suPAR levels in predicting: 30 day and 90-day mortality, 30-day readmission, early discharge (within 24hr), and LOS in patients coming to AMU. RESULTS A total of 13 studies were included, with a population size of 35,178, of which 52.9% were female with a mean age of 62.93 years. Increased risk of 30-day mortality (RR = 10.52; 95% CI = 4.82-22.95; I2 = 38%; P < .00001), and risk of 90-day mortality (RR = 5.76; 95% CI = 3.35-9.91; I2 = 36%; P < .00001) was observed in high suPAR patients. However, a slightly increased risk was observed for 30-day readmission (RR = 1.50; 95% CI = 1.16-1.94; I2 = 54%; P = .002). More people were discharged within 24hr in the low suPAR level group compared to high suPAR group (RR = 0.46; 95% CI = 0.40-0.53; I2 = 41%; P < .00001). LOS was thrice as long in high suPAR level patients than in patients with low suPAR (WMD = 3.20; 95% CI = 1.84-4.56; I2 = 99%; P < .00001). CONCLUSION suPAR is proven to be a significant marker in predicting 30-day and 90-day mortality in ED patients.
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Affiliation(s)
| | | | - Eman Ali
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Asim Shaikh
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Gibran Ali
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic - Rochester, NY, USA
| | - Zohaib Yousaf
- Department of Internal Medicine, Tower Health - Reading Hospital, PA, USA
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An S, Yao Y, Hu H, Wu J, Li J, Li L, Wu J, Sun M, Deng Z, Zhang Y, Gong S, Huang Q, Chen Z, Zeng Z. PDHA1 hyperacetylation-mediated lactate overproduction promotes sepsis-induced acute kidney injury via Fis1 lactylation. Cell Death Dis 2023; 14:457. [PMID: 37479690 PMCID: PMC10362039 DOI: 10.1038/s41419-023-05952-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/24/2023] [Accepted: 07/05/2023] [Indexed: 07/23/2023]
Abstract
The increase of lactate is an independent risk factor for patients with sepsis-induced acute kidney injury (SAKI). However, whether elevated lactate directly promotes SAKI and its mechanism remain unclear. Here we revealed that downregulation of the deacetylase Sirtuin 3 (SIRT3) mediated the hyperacetylation and inactivation of pyruvate dehydrogenase E1 component subunit alpha (PDHA1), resulting in lactate overproduction in renal tubular epithelial cells. We then found that the incidence of SAKI and renal replacement therapy (RRT) in septic patients with blood lactate ≥ 4 mmol/L was increased significantly, compared with those in septic patients with blood lactate < 2 mmol/L. Further in vitro and in vivo experiments showed that additional lactate administration could directly promote SAKI. Mechanistically, lactate mediated the lactylation of mitochondrial fission 1 protein (Fis1) lysine 20 (Fis1 K20la). The increase in Fis1 K20la promoted excessive mitochondrial fission and subsequently induced ATP depletion, mitochondrial reactive oxygen species (mtROS) overproduction, and mitochondrial apoptosis. In contrast, PDHA1 activation with sodium dichloroacetate (DCA) or SIRT3 overexpression decreased lactate levels and Fis1 K20la, thereby alleviating SAKI. In conclusion, our results show that PDHA1 hyperacetylation and inactivation enhance lactate overproduction, which mediates Fis1 lactylation and exacerbates SAKI. Reducing lactate levels and Fis1 lactylation attenuate SAKI.
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Affiliation(s)
- Sheng An
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yi Yao
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Hongbin Hu
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Junjie Wu
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Jiaxin Li
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Lulan Li
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jie Wu
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Maomao Sun
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhiya Deng
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yaoyuan Zhang
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Shenhai Gong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Qiaobing Huang
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhongqing Chen
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Zhenhua Zeng
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.
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Tibi S, Zeynalvand G, Mohsin H. Role of the Renin Angiotensin Aldosterone System in the Pathogenesis of Sepsis-Induced Acute Kidney Injury: A Systematic Review. J Clin Med 2023; 12:4566. [PMID: 37510681 PMCID: PMC10380384 DOI: 10.3390/jcm12144566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Sepsis is a life-threatening condition responsible for up to 20% of all global deaths. Kidneys are among the most common organs implicated, yet the pathogenesis of sepsis-induced acute kidney injury (S-AKI) is not completely understood, resulting in the treatment being nonspecific and responsive. In situations of stress, the renin angiotensin aldosterone system (RAAS) may play a role. This systematic review focuses on analyzing the impact of the RAAS on the development of S-AKI and discussing the use of RAAS antagonists as an emerging therapeutic option to minimize complications of sepsis. METHODS Studies were identified using electronic databases (Medline via PubMed, Google Scholar) published within the past decade, comprised from 2014 to 2023. The search strategy was conducted using the following keywords: sepsis, S-AKI, RAAS, Angiotensin II, and RAAS inhibitors. Studies on human and animal subjects were included if relevant to the keywords. RESULTS Our search identified 22 eligible references pertaining to the inclusion criteria. Treatment of sepsis with RAAS inhibitor medications is observed to decrease rates of S-AKI, reduce the severity of S-AKI, and offer an improved prognosis for septic patients. CONCLUSION The use of RAAS antagonists as a treatment after the onset of sepsis has promising findings, with evidence of decreased renal tissue damage and rates of S-AKI and improved survival outcomes. REGISTRATION INPLASY202360098.
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Affiliation(s)
- Sedra Tibi
- School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA
| | - Garbel Zeynalvand
- School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA
| | - Hina Mohsin
- School of Medicine, California University of Science and Medicine, Colton, CA 92324, USA
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Kwak SH, Ahn S, Shin MH, Leem AY, Lee SH, Chung K, Kim YS, Lee SG, Park MS. Identification of Biomarkers for the Diagnosis of Sepsis-Associated Acute Kidney Injury and Prediction of Renal Recovery in the Intensive Care Unit. Yonsei Med J 2023; 64:181-190. [PMID: 36825344 PMCID: PMC9971432 DOI: 10.3349/ymj.2022.0324] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE Acute kidney injury (AKI) following sepsis is associated with higher mortality; however, reliable biomarkers for AKI development and recovery remain to be elucidated. MATERIALS AND METHODS Patients with sepsis admitted to the medical intensive care unit (ICU) of Severance Hospital between June 2018 and May 2019 were prospectively analyzed. Patients were divided into those with and without AKI within 48 hours. Patients with septic AKI were subdivided into AKI-recovery and non-recovery groups based on whether their kidney injury recovered within 7 days. RESULTS A total of 84 patients were enrolled. The baseline creatinine (2.9 mg/dL vs. 0.8 mg/dL vs. 1.2 mg/dL, p<0.001), Charlson Comorbidity Index (4.5 vs. 2.0 vs. 3.0, p=0.002), Sequential Organ Failure Assessment (10.0 vs. 6.5 vs. 8.0, p<0.001), and Acute Physiology and Chronic Health Evaluation II scores (32.0 vs. 21.5 vs. 30.5, p=0.004) were higher in the non-recovery AKI group compared to the non-AKI and AKI-recovery groups. The Kaplan-Meier curves revealed that non-recovery from AKI was associated with lower survival (p<0.001). High-lactate (p≤0.05) and kynurenine levels (p≤0.05) were associated with non-recovery of renal function following AKI. The areas under the curve for predicting non-recovery from AKI were 0.693 and 0.721 for lactate and kynurenine, respectively. The survival rate was lower in the high-kynurenine (p=0.040) and high-lactate (p=0.010) groups. CONCLUSION The mortality of patients who recovered from AKI was comparable to that of patients without AKI. Lactate and kynurenine could be useful biomarkers for the diagnosis and recovery of AKI following sepsis.
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Affiliation(s)
- Se Hyun Kwak
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sunyoung Ahn
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Hwa Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungsoo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Development of an acute kidney injury risk prediction model for patients undergoing extracorporeal membrane oxygenation. Heliyon 2022; 8:e12585. [PMID: 36643308 PMCID: PMC9834743 DOI: 10.1016/j.heliyon.2022.e12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 12/27/2022] Open
Abstract
Background Some studies have reported to use some predictors before extracorporeal membrane oxygenation (ECMO) initiation to predict the acute kidney injury (AKI) risk. However, injury during the ECMO operation and the response of patients to ECMO may significantly influence the prognosis, and they are unpredictable before ECMO initiation. This study aims to develop a potential model based clinical characteristics at the 2-hour time point during ECMO for the early prediction of AKI in patients receiving ECMO. Methods 139 patients who underwent ECMO were enrolled in this study. The clinical characteristics and the laboratory examinations at 2-hour time point during ECMO were recorded. The least absolute shrinkage and selection operator (LASSO) regression method was performed to select predictors, and logistic regression and a nomogram were used to establish the prediction model. The area under curve (AUC) of the receiver operating characteristic and calibration curve were used to analyze the discrimination and calibration of the model. K-fold cross-validation method was performed to validate the accuracy of this model. Results Among the 139 patients receiving ECMO, 106 participants (76.26%) developed AKI. Four predictive variables including ECMO model, serum creatinine (Scr-2h), uric acid(UA-2h), and serum lactate (Lac-2h) at the 2-hour time point during ECMO were filtered from 39 clinical parameters by LASSO regression. These four predictors were incorporated to develop a model for predicting AKI risk using logistic regression. The AUC of the model was 0.905 (0.845-0.965), corresponding to 81.1% sensitivity, 90.9% specificity and 83.5% accuracy. Moreover, this model showed good consistency between observed and predicted probability based on the calibration curve (P > 0.05). The validation performed by K-fold cross-validation method showed that the accuracy was 0.874 ± 0.006 in training sets, 0.827 ± 0.053 in test sets, indicating a good capability for AKI risk prediction. Finally, a nomogram based on this model was constructed to facilitate its use in clinical practice. Conclusion The nomogram incorporating Scr-2h,Lac-2h, UA-2h, and ECMO model may facilitate the individualized prediction of the AKI risk among patients undergoing ECMO.
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Fan Y, Chen L, Jiang S, Huang Y, Leng Y, Gao C. Timely renal replacement therapy linked to better outcome in patients with sepsis-associated acute kidney injury. JOURNAL OF INTENSIVE MEDICINE 2022; 2:173-182. [PMID: 36789016 PMCID: PMC9923993 DOI: 10.1016/j.jointm.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/27/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
Background Recent studies suggest that acute kidney injury (AKI) can be treated with renal replacement therapy (RRT). However, its benefits to patients with sepsis-associated AKI (SA-AKI), which is linked to high mortality and morbidity rates, remain under debate. The aim of this study was to compare the outcomes of different RRT strategies for patients with SA-AKI. Methods This retrospective study evaluated patients who were admitted to the hospital with sepsis and developed SA-AKI during hospitalization from 1st January 2014 to 31st January 2019. Mortality, renal recovery, and systemic organ function at 90 days following admission were compared between the RRT group (RG) and non-RRT group (NRG), as well as the early-RRT group (EG) and delayed-RRT group (DG). The groups were defined according to the time from admission to RRT initiation (criterion 1, EG1 and DG1) and Kidney Disease Improving Global Outcomes (KDIGO) classification (criterion 2, EG2 and DG2). Categorical and continuous variables were compared using the chi-squared test or Fisher's exact test and Student's t-test or Wilcoxon test. Kaplan-Meier curves were constructed to determine the unadjusted survival rates for the different subgroups. Results A total of 116 patients were included in this study; of those, 38 received RRT and 46 expired within 90 days. Among different strategies of RRT, there were no significant differences found in 90-day mortality (RG vs. NRG: χ2=0.610, P=0.435; EG1 vs. DG1: χ2 =0.835, P=0.360; EG2 vs. DG2: χ2=0.022, P=0.899) and renal recovery. However, the values of change in sequential organ failure assessment (ΔSOFA)max-min of patients in the EG and RG were significantly higher than those recorded in the NRG (ΔSOFARG=7.0, ΔSOFANRG=3.60, ΔSOFAEG1=9.00, ΔSOFAEG2=6.30; P<0.050). Also, the 90-day renal recovery in the EG was better than that noted in the DG with criterion 1 (87.5% vs. 38.5%, respectively, χ2=10.425, P=0.032), suggesting that RRT (especially timely RRT) may be beneficial to the restoration of systemic organ function in patients with SA-AKI. Conclusion RRT did not reduce the 90-day mortality among patients with SA-AKI. However, timely RRT may benefit the restoration of systemic organ function, thereby improving the quality of life of patients.
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Affiliation(s)
- Yiwen Fan
- Department of Emergency, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Gronigen 9713GZ, the Netherlands
| | - Liang Chen
- Department of Emergency, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Shaowei Jiang
- Department of Emergency, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yingying Huang
- Department of Emergency, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yuxin Leng
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
- Corresponding authors: Chengjin Gao, Department of Emergency, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; Yuxin Leng, Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China.
| | - Chengjin Gao
- Department of Emergency, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
- Corresponding authors: Chengjin Gao, Department of Emergency, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; Yuxin Leng, Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China.
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Yang K, Fan M, Wang X, Xu J, Wang Y, Gill PS, Ha T, Liu L, Hall JV, Williams DL, Li C. Lactate induces vascular permeability via disruption of VE-cadherin in endothelial cells during sepsis. SCIENCE ADVANCES 2022; 8:eabm8965. [PMID: 35476437 PMCID: PMC9045716 DOI: 10.1126/sciadv.abm8965] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Circulating lactate levels are a critical biomarker for sepsis and are positively correlated with sepsis-associated mortality. We investigated whether lactate plays a biological role in causing endothelial barrier dysfunction in sepsis. We showed that lactate causes vascular permeability and worsens organ dysfunction in CLP sepsis. Mechanistically, lactate induces ERK-dependent activation of calpain1/2 for VE-cadherin proteolytic cleavage, leading to the enhanced endocytosis of VE-cadherin in endothelial cells. In addition, we found that ERK2 interacts with VE-cadherin and stabilizes VE-cadherin complex in resting endothelial cells. Lactate-induced ERK2 phosphorylation promotes ERK2 disassociation from VE-cadherin. In vivo suppression of lactate production or genetic depletion of lactate receptor GPR81 mitigates vascular permeability and multiple organ injury and improves survival outcome in polymicrobial sepsis. Our study reveals that metabolic cross-talk between glycolysis-derived lactate and the endothelium plays a critical role in the pathophysiology of sepsis.
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Affiliation(s)
- Kun Yang
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
- Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
| | - Min Fan
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
- Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
| | - Xiaohui Wang
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
- Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
| | - Jingjing Xu
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Yana Wang
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - P. Spencer Gill
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
| | - Tuanzhu Ha
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
- Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
| | - Li Liu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jennifer V. Hall
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
- Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
| | - David L. Williams
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
- Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
| | - Chuanfu Li
- Department of Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA
- Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, TN 37614, USA
- Corresponding author.
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Shahrami B, Sefidani Forough A, Khezrnia SS, Najmeddin F, Arabzadeh AA, Rouini MR, Najafi A, Mojtahedzadeh M. Relationship between amikacin pharmacokinetics and biological parameters associated with organ dysfunction: a case series study of critically ill patients with intra-abdominal sepsis. Eur J Hosp Pharm 2022; 29:e72-e76. [PMID: 34764144 PMCID: PMC8899638 DOI: 10.1136/ejhpharm-2021-003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the relationship between amikacin pharmacokinetics and the biomarkers associated with organ dysfunction in critically ill patients with intra-abdominal sepsis. METHODS A case series involving critically ill patients with intra-abdominal sepsis who received an amikacin loading dose of 20-25 mg/kg intravenous infusion was studied. The 1-, 2-, 4-, 6- and 24-hour amikacin serum concentrations were measured to calculate the pharmacokinetic parameters. The Sequential Organ Failure Assessment (SOFA) score, white blood cells, neutrophil to lymphocyte ratio, platelet count, serum creatinine, creatinine clearance, bilirubin, partial pressure of oxygen to fraction of inspired oxygen ratio, serum albumin, procalcitonin, lactate level, erythrocyte sedimentation rate (ESR) and C-reactive protein were recorded. A linear regression analysis was performed to examine the relationship between the amikacin pharmacokinetics and the biological parameters. RESULTS Twenty-one patients were studied. A significant correlation was found between the volume of distribution and ESR (p<0.05, r=0.844). Moreover, drug clearance had a significant inverse correlation with serum lactate (p<0.05, r=-0.603). No other significant correlations were found. CONCLUSIONS ESR and serum lactate were identified as useful predictors of amikacin pharmacokinetics in critically ill patients with intra-abdominal sepsis and may help guide the selection of appropriate empirical dosing.
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Affiliation(s)
- Bita Shahrami
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Seyedeh Sana Khezrnia
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Farhad Najmeddin
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Amir Ahmad Arabzadeh
- Department of Surgery, Ardabil University of Medical Sciences, Ardabil, The Islamic Republic of Iran
| | - Mohammad Reza Rouini
- Department of Pharmaceutics, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Atabak Najafi
- Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, The Islamic Republic of Iran
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12
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Wang Z, Zhang L, Xu F, Han D, Lyu J. The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units. BMC Emerg Med 2022; 22:32. [PMID: 35227200 PMCID: PMC8886847 DOI: 10.1186/s12873-022-00589-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Sepsis has high incidence and fatality rates in intensive care units, often leading to renal failure. The effectiveness of continuous renal replacement therapy (CRRT) in sepsis-associated acute kidney injury (S-AKI) patients is currently uncertain. Aim Joint model was used to determine the association between CRRT and the lactate trajectory trend and how it correlated to 28-day mortality for S-AKI patient in ICU. Methods A retrospective study was applied to patients with sepsis and AKI, which were extracted from the MIMIC-III public database, with the endpoint being 28-day mortality. Every lactate level measurement within 28 days was observed and calculated using logarithms. Joint model combined the longitudinal analysis of the natural logarithm of the lactate level [log(lactate)] in longitudinal submodel and Cox regression by trajectory function, demonstrating the effects of CRRT on 28-day survival and log(lactate) changes, and its final relationship with the event status. Results Among the 717 S-AKI patients, 157 received CRRT. CRRT was not associated with 28-day mortality. After adjustments, the relationship between CRRT use and log(lactate) elevation was statistically significant. The parameter estimation of CRRT and log(lactate) indicated that using CRRT will increase log(lactate) by 0.041 in S-AKI patients. The joint model also instigated a fixed association between changes in the lactate level and the event result, revealing an exp value of (0.755) = 2.12, indicating that an increase of one unit in log(lactate) will increase the risk of 28-day mortality 2.12-times. Conclusion There was no significant association between CRRT use and 28-day survival in S-AKI patients, and JM showed that CRRT use might be associated with elevation of longitudinal lactate levels. Therefore, additional attention should be paid to other treatments to control lactate levels when providing renal support for patients with S-AKI. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00589-6.
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Affiliation(s)
- Zichen Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,Department of Public Health, University of California, Irvine, USA
| | - Luming Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
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Wang R, Wang S, Zhang J, He M, Xu J. Serum Lactate Level in Early Stage Is Associated With Acute Kidney Injury in Traumatic Brain Injury Patients. Front Surg 2022; 8:761166. [PMID: 35174203 PMCID: PMC8841417 DOI: 10.3389/fsurg.2021.761166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/24/2021] [Indexed: 01/27/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common complication in the clinical practice of managing patients with traumatic brain injury (TBI). Avoiding the development of AKI is beneficial for the prognosis of patients with TBI. We designed this study to testify whether serum lactate could be used as a predictive marker of AKI in patients with TBI. Materials and Methods In total, 243 patients with TBI admitted to our hospital were included in this study. Univariate and multivariate logistic regression analyses were utilized to analyze the association between lactate and AKI. The receiver operating characteristic (ROC) curves were drawn to verify the predictive value of lactate and the logistic model. Results Acute kidney injury group had higher age (p = 0.016), serum creatinine (p < 0.001), lactate (p < 0.001), and lower Glasgow Coma Scale (GCS; p = 0.021) than non-AKI group. Multivariate logistic regression showed that age [odds ratio (OR) = 1.026, p = 0.022], serum creatinine (OR = 1.020, p = 0.010), lactate (OR = 1.227, p = 0.031), fresh frozen plasma (FFP) transfusion (OR = 2.421, p = 0.045), and platelet transfusion (OR = 5.502, p = 0.044) were risk factors of AKI in patients with TBI. The area under the ROC curve (AUC) values of single lactate and predictive model were 0.740 and 0.807, respectively. Conclusion Serum lactate level in the early phase is associated with AKI in patients with TBI. Lactate is valuable for clinicians to evaluate the probability of AKI in patients with TBI.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shaobo Wang
- Department of Infectious Diseases, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Min He
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Jianguo Xu
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14
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Estimated glomerular filtration rate may be an independent predictor for clinical outcomes regardless of acute kidney injury complication in the emergency department. PLoS One 2021; 16:e0258665. [PMID: 34648576 PMCID: PMC8516290 DOI: 10.1371/journal.pone.0258665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Study objective Acute kidney injury (AKI), chronic kidney disease (CKD), and decreased estimated glomerular filtration rate (eGFR) are all associated with poor clinical outcomes among emergency department (ED) patients. This study aimed to evaluate the effect of different types of renal dysfunction and the degree of eGFR reduction on the clinical outcomes in a real-world ED setting. Methods Adult patients with an eGFR lower than 60 mL/min/1.73m2 in our ED, from October 1, 2016, to December 31, 2016, were enrolled in this retrospective observational study. Besides AKI and CKD, patients with unknown baseline renal function before an ED visit were categorized in the undetermined renal dysfunction (URD) category. Results Among 1495 patients who had eGFR evaluation at ED, this study finally enrolled 441 patients; 22 patients (5.0%) had AKI only, 32 (7.3%) had AKI on CKD, 196 (44.4%) had CKD only, 27 (6.1%) had subclinical kidney injury (those who met neither criteria for AKI nor CKD), and 164 (37.2%) had URD. There was a significant association between eGFR and critical illness defined as the composite outcome of death or intensive care unit (ICU) need, hospitalization, ICU need, death, and renal replacement therapy need (odds ratio [95% confidence interval]: 1.72 [1.45–2.05], 1.36 [1.16–1.59], 1.66 [1.39–2.00], 1.73 [1.32–2.28], and 2.71 [1.73–4.24] for every 10 mL/min/1.73m2 of reduction, respectively). Multivariate logistic regression analysis showed eGFR was an independent predictor of critical illness composite outcome (death or ICU need), hospitalization, and ICU need even after adjustment with AKI or URD. Conclusions Estimated GFR may be a sufficient predictor of clinical outcomes of ED patients regardless of AKI complication. Considerable ED patients were determined as URD, which might have a significant impact on the ED statistics regarding renal dysfunction.
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Kimweri D, Ategeka J, Ceasor F, Muyindike W, Nuwagira E, Muhindo R. Incidence and risk predictors of acute kidney injury among HIV-positive patients presenting with sepsis in a low resource setting. BMC Nephrol 2021; 22:238. [PMID: 34187389 PMCID: PMC8243728 DOI: 10.1186/s12882-021-02451-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality. In our resource-limited setting (RLS), the most common cause of AKI is sepsis and volume depletion. Sepsis alone, accounts for up to 62 % of the AKI cases in HIV-positive patients. OBJECTIVE The major goal of this study was to determine the incidence and risk predictors of AKI among HIV-infected patients admitted with sepsis at a tertiary hospital in Uganda. METHODS In a prospective cohort study, we enrolled adult patients presenting with sepsis at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between March and July 2020. Sepsis was determined using the qSOFA criteria. Patients presenting with CKD or AKI were excluded. Sociodemographic characteristics, physical examination findings, and baseline laboratory values were recorded in a data collection tool. The serum creatinine and urea were done at admission (0-hour) and at the 48-hour mark to determine the presence of AKI. We performed crude and multivariable binomial regression to establish the factors that predicted developing AKI in the first 48 h of admission. Variables with a p < 0.01 in the adjusted analysis were considered as significant predictors of AKI. RESULTS Out of 384 patients screened, 73 (19 %) met our inclusion criteria. Their median age was 38 (IQR 29-46) years and 44 (60.3 %) were male. The median CD4 T-cell count was 67 (IQR 35-200) cells, median MUAC was 23 (IQR 21-27) cm and 54 (74.0 %) participants were on a regimen containing Tenofovir Disoproxil Fumarate (TDF). The incidence of AKI in 48 h was 19.2 % and in the adjusted analysis, thrombocytopenia (Platelet count < 150) (adjusted risk ratio 8.21: 95 % CI: 2.0-33.8, p = 0.004) was an independent predictor of AKI. CONCLUSIONS There is a high incidence of AKI among HIV-positive patients admitted with sepsis in Uganda. Thrombocytopenia at admission may be a significant risk factor for developing AKI. The association of thrombocytopenia in sepsis and AKI needs to be investigated.
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Affiliation(s)
- Davis Kimweri
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda.
| | - Julian Ategeka
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Faustine Ceasor
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda.,Immunosuppression Clinic, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Edwin Nuwagira
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
| | - Rose Muhindo
- Department of Internal Medicine, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda
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Prognostic Impact of Parameters of Metabolic Acidosis in Critically Ill Children with Acute Kidney Injury: A Retrospective Observational Analysis Using the PIC Database. Diagnostics (Basel) 2020; 10:diagnostics10110937. [PMID: 33187169 PMCID: PMC7696045 DOI: 10.3390/diagnostics10110937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) is a major complication of sepsis that induces acid-base imbalances. While creatinine levels are the only indicator for assessing the prognosis of AKI, prognostic importance of metabolic acidosis is unknown. We conducted a retrospective observational study by analyzing a large China-based pediatric critical care database from 2010 to 2018. Participants were critically ill children with AKI admitted to intensive care units (ICUs). The study included 1505 children admitted to ICUs with AKI, including 827 males and 678 females. The median age at ICU admission was 22 months (interquartile range 7–65). After a median follow-up of 10.87 days, 4.3% (65 patients) died. After adjusting for confounding factors, hyperlactatemia, low pH, and low bicarbonate levels were independently associated with 28-day mortality (respective odds ratio: 3.06, 2.77, 2.09; p values: <0.01, <0.01, <0.01). The infection had no interaction with the three parameters. The AKI stage negatively interacted with bicarbonate and pH but not lactate. The current study shows that among children with AKI, hyperlactatemia, low pH, and hypobicarbonatemia are associated with 28-day mortality.
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Rates, predictors, and mortality of sepsis-associated acute kidney injury: a systematic review and meta-analysis. BMC Nephrol 2020; 21:318. [PMID: 32736541 PMCID: PMC7393862 DOI: 10.1186/s12882-020-01974-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Due to the high incidence and mortality of sepsis-associated acute kidney injury, a significant number of studies have explored the causes of sepsis-associated acute kidney injury (AKI). However, the opinions on relevant predictive risk factors remain inconclusive. This study aimed to provide a systematic review and meta-analysis to determine the predisposing factors for sepsis-associated AKI. METHOD A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed, and Web of Science, databases, with an end-date of 25th May 2019. Valid data were retrieved in compliance with specific inclusion and exclusion criteria. RESULT Forty-seven observational studies were included for analysis, achieving a cumulative patient number of 55,911. The highest incidence of AKI was caused by septic shock. Thirty-one potential risk factors were included in the meta-analysis. Analysis showed that 20 factors were statistically significant. The odds ratio (OR) and 95% confidence interval (CI), as well as the prevalence of the most frequently-seen predisposing factors for sepsis-associated AKI, were as follows: septic shock [2.88 (2.36-3.52), 60.47%], hypertension [1.43 (1.20-1.70), 38.39%], diabetes mellitus [1.59 (1.47-1.71), 27.57%], abdominal infection [1.44 (1.32-1.58), 30.87%], the administration of vasopressors [2.95 (1.67-5.22), 64.61%], the administration of vasoactive drugs [3.85 (1.89-7.87), 63.22%], mechanical ventilation [1.64 (1.24-2.16), 68.00%], positive results from blood culture [1.60 (1.35-1.89), 41.19%], and a history of smoking [1.60 (1.09-2.36), 43.09%]. Other risk factors included cardiovascular diseases, coronary artery diseases, liver diseases, unknown infections, the administration of diuretics and ACEI/ARB, the infection caused by gram-negative bacteria, and organ transplantation. CONCLUSION Risk factors of S-AKI arise from a wide range of sources, making it difficult to predict and prevent this condition. Comorbidities, and certain drugs, are the main risk factors for S-AKI. Our review can provide guidance on the application of interventions to reduce the risks associated with sepsis-associated acute kidney injury and can also be used to tailor patient-specific treatment plans and management strategies in clinical practice.
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