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Predicting Risk Factors of Acute Kidney Injury in the First 7 Days after Admission: Analysis of a Group of Critically Ill Patients. Cardiovasc Ther 2022; 2022:1407563. [PMID: 36628120 PMCID: PMC9797299 DOI: 10.1155/2022/1407563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/22/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication in critically ill patients. Some predictive models have been reported, but the conclusions are controversial. The aim of this study was the formation of nomograms to predict risk factors for AKI in critically ill patients within the first 7 days after admission to the intensive care unit (ICU). Methods Data were extracted from the Medical Information Mart for Intensive Care- (MIMIC-) III database. The random forest method was used to fill in the missing values, and least absolute shrinkage and selection operator (Lasso) regression analysis was performed to screen for possible risk factors. Results A total of 561 patients were enrolled. Complication with AKI is significantly associated with a longer length of stay (LOS). For all patients, the predictors contained in the prediction nomogram included hypertension, coronary artery disease (CAD), cardiopulmonary bypass (CPB), coronary artery bypass grafting (CABG), Simplified Acute Physiology Score II (SAPS II), central venous pressure (CVP) measured for the first time after admission, and maximum and minimum mean artery pressure (MAP). The model showed good discrimination (C - index = 0.818, 95% CI: 0.779-0.857). In the subgroup of patients with well-controlled blood glucose levels, the significant predictors included hypertension, CABG, CPB, SAPS II, and maximum and minimum MAP. Good discrimination was also present before (C - index = 0.785, 95% CI: 0.736-0.834) and after adjustment (adjusted C - index = 0.770). Conclusion Hypertension, CAD, CPB, CABG, SAPS II, CVP measured for the first time after admission, and maximum and minimum MAP were independent risk factors for AKI in critically ill patients.
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Urinary Sodium/Potassium Ratio in Acute Kidney Injury Accurately Differentiates Prerenal Azotemia from Acute Tubular Necrosis. ACTA MEDICA MARISIENSIS 2019. [DOI: 10.2478/amma-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: To develop a more accurate, cost effective, non-invasive test to differentiate between pre-renal renal failure (PRA) and acute tubular necrosis (ATN) in acute kidney injury (AKI).
Methods: Urine sodium/potassium (Na/K) ratios were compared with fractional excretion of sodium (FeNa) and renal failure index (RFI) as well as other commonly used indices to differentiate patients with PRA from ATN. Patients with a rise in serum creatinine > 0.5 mg/d identified from medical records for a six- to eighteen-month period, were reviewed and categorized either as PRA or ATN based on presenting findings, course in hospital or renal biopsy. All patients had urinary sodium and potassium, creatinine, and serum creatinine done.
Results: The Na/K was < 1 in PRA and > 1 in ATN, correctly identifying all 42 cases of PRA and all 28 patients with ATN. The FeNa was >1 and misdiagnosed 9 of 42 patients with PRA and was >1 and correctly diagnosed all patients with ATN. The RFI was >1 and misdiagnosed 11 of 42 patients with PRA but was >1 and correctly diagnosed all patients with ATN. The BUN/creatinine ratio, urine sodium concentration and U/P creatinine ratio all had a very poor correlation with the correct diagnosis.
Conclusion: The Na/K ratio correctly diagnosed all 42 cases of PRA and all 28 cases of ATN. It is easy to do, is cost effective, non-invasive, and is useful for following patients with PRA to see if and when they develop ATN.
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A simple risk score for prediction of sepsis associated-acute kidney injury in critically ill patients. J Nephrol 2019; 32:947-956. [PMID: 31313123 DOI: 10.1007/s40620-019-00625-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sepsis is common and frequently fatal condition in critically ill patients and is a major cause of acute kidney injury (AKI). In this retrospective study, we sought to develop a comprehensive risk score model of sepsis associated-AKI (SA-AKI). METHODS A total of 2617 patients were randomly assigned to a development (1554 patients) and a validation group (777 patients). The risk score model for SA-AKI was developed with multivariate regression analysis in development group and the model was further evaluated on validation group. RESULTS We identified 16 independent predictors of SA-AKI in development group (age ≥ 60 years, hypertension/coronary heart disease, diabetes, chronic kidney disease, heart failure, chronic obstructive pulmonary disease, acute severe pancreatitis, hypotension, hypoproteinemia, lactic acidosis, the length of stay in intensive care unit(ICU), 60 g/L<hemoglobin < 90 g/L, hemoglobin ≤ 60 g/L, and ≥ 2 failed organs. This model had excellent performance characteristics in validation cohort(c statistic 0.857, 95% CI 0.839-0.874). CONCLUSION The novel risk score model for SA-AKI in ICU can identify patients at high risk to develop AKI. Application of this model could help clinicians to stratify patients for primary prevention, surveillance and early therapeutic intervention to improve care and prognosis of sepsis patients in ICU.
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Ahmed MEH, Hamed G, Fawzy S, Taema KM. Lung injury prediction scores: Clinical validation and C-reactive protein involvement in high risk patients. Med Intensiva 2019; 44:267-274. [PMID: 30987877 DOI: 10.1016/j.medin.2019.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE A study was made to validate two previously derived lung injury prediction scores (LIPS) for the prediction of acute respiratory distress syndrome (ARDS) in high risk intensive care patients, with the incorporation of C-reactive protein (CRP) for improving score accuracy. DESIGN A prospective, observational cohort study was carried out. PATIENTS A total of 200 patients with APACHE II score ≥15 and at least one ARDS risk factor upon ICU admission were included. INTERVENTIONS Calculation of LIPS using formulas developed by Cartin-Ceba et al. (2009) and Trillo-Alvarez et al. (2011) (LIPS-2009 and LIPS-2011). C-reactive protein was measured upon admission (CRP-0) and after 48h (CRP-48). MAIN VARIABLES OF INTEREST Independent variables: LIPS-2009, LIPS-2011 and CRP values. Dependent variable: development of ARDS. RESULTS Eighty-eight patients (44%) developed ARDS after a median (Q1-Q3) of 2.5 (1.3-6.8) days. The LIPS-2009 and LIPS-2011 scores were 4 (3-6) and 5 (3.6-6.5) in ARDS patients compared to 2 (1-4) and 3.5 (1.5-4.5) in non-ARDS patients (p<0.001). CRP-48 was 96 (67.5-150.3)mg/L and 48 (24-96)mg/L in the two groups, respectively (p<0.001). ΔCRP (i.e., CRP-48 minus CRP-0) was significantly higher in the ARDS patients (p<0.001). The AUC was 0.740 and 0.738 for LIPS-2011 and LIPS-2009, respectively - the difference being nonsignificant (p=0.9, 0.9 and 0.8 for pairwise comparison of the different ROC curves). Integrating ΔCRP with LIPS-2011 using binary logistic regression analysis identified a new score (LIPS-N) with AUC 0.803, which was significantly higher than the AUC of LIPS-2011 (p=0.01). CONCLUSIONS Both LIPS scores are equally effective in predicting ARDS in high risk ICU patients. Integrating the change in CRP within the score might improve its accuracy.
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Affiliation(s)
- M E-H Ahmed
- Critical Care Medicine Department, Al-Haram Hospital, Cairo, Egypt
| | - G Hamed
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - S Fawzy
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - K M Taema
- Critical Care Medicine Department, Cairo University, Cairo, Egypt.
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Assessment of tumor necrosis factor alpha polymorphism TNF-α -238 (rs 361525) as a risk factor for development of acute kidney injury in critically ill patients. Mol Biol Rep 2018; 45:839-847. [PMID: 29978383 DOI: 10.1007/s11033-018-4230-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/28/2018] [Indexed: 12/29/2022]
Abstract
Critically ill patients revealed significant adverse outcomes (sepsis, septic shock, organ dysfunction/failure, and mortality) despite variable effort. AIM this study evaluated the association of TNF-a-238 (rs 361525) with adverse outcomes in critically ill patients. TNF-α-238 (rs 361525) SNP was performed by RT-PCR on 200 critically-ill patients (112 had severe sepsis and septic shock and 88 were septic), 127 of them had AKI. Urinary N-acetyl-β-(D)-glucosaminidase and serum creatinine were assessed by modified Jaffé and ELISA respectively. These results revealed that heterozygous genotype GA of TNF-α-238 (rs 361525) SNP significantly increased the risk of adverse-outcome (mortality rate) (P = 0.0001; OR 8.9), regardless of organ dysfunction (P = 0.09) or severity of sepsis (P = 0.6). Moreover, heterozygous genotype GA of TNF-α-238 (rs 361525) SNP was significantly associated with inflammatory marker (sTNF-α) (P = 0.014) and tubular injury marker (uNAG) (P = 0.001) that displayed a significant association with severity of sepsis (0.001, 0.035) and organ dysfunction (0.012, 0.0001) respectively. In critically ill patients with sepsis induced AKI, serum TNF-α and uNAG measured at admission can predict severity of sepsis and AKI (defined by REFILE) occurrence along with pre-existing CKD and DM. However, TNF-238 yielded additional prognostic information on ICU mortality irrelevant to AKI in septic patients.
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Abstract
Since its discovery in 1988, B-type natriuretic peptide (BNP) has been recognized as a powerful cardiovascular biomarker for a number of disease states, specifically heart failure. Concurrent with such a discovery, much effort has been allocated to the precise monitoring of physiological BNP levels. Thus, it can be used to guide the therapy of heart failure and determine the patient's stage of disease. Thus, we discuss in this article BNP as a potent biomarker. Subsequently, we will review the progress of biosensing devices as they could be applied to monitor BNP levels as assays, benchtop biosensors and implantable biosensors. The analytical characteristics of commercially available BNP assays are presented. Still emerging as a field, we define four obstacles that present opportunity for the future development of implantable biosensor: foreign body response, sensor renewability, sensitivity and selectivity.
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Bevc S, Ekart R, Hojs R. The assessment of acute kidney injury in critically ill patients. Eur J Intern Med 2017; 45:54-58. [PMID: 28982602 DOI: 10.1016/j.ejim.2017.09.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 01/10/2023]
Abstract
Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. The availability of several biomarkers of kidney injury offers new tools for its early recognition and management. The early identification of high-risk patients provides an opportunity to develop strategies for the prevention, early diagnosis and treatment of AKI. Despite progress in critical care medicine over the past decade, the treatment strategies for AKI in critically ill patients, such as when to start renal replacement therapy, remain controversial. A recently proposed risk prediction score for AKI, based on routinely available clinical variables, presents a new means of identifying patients at high risk of AKI.
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Affiliation(s)
- Sebastjan Bevc
- Clinic for Internal Medicine, Department of Nephrology, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia.
| | - Robert Ekart
- Department of Dialysis, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia.
| | - Radovan Hojs
- Clinic for Internal Medicine, Department of Nephrology, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia.
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Grande D, Leone M, Rizzo C, Terlizzese P, Parisi G, Gioia MI, Leopizzi T, Segreto A, Guida P, Romito R, Ciccone MM, Serio FD, Iacoviello M. A Multiparametric Approach Based on NT-proBNP, ST2, and Galectin3 for Stratifying One Year Prognosis of Chronic Heart Failure Outpatients. J Cardiovasc Dev Dis 2017; 4:jcdd4030009. [PMID: 29367540 PMCID: PMC5715710 DOI: 10.3390/jcdd4030009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/06/2017] [Accepted: 07/14/2017] [Indexed: 12/19/2022] Open
Abstract
Galectin-3 and ST2 are emerging biomarkers involved in myocardial fibrosis. We evaluate the relevance of a multiparametric biomarker approach based on increased serum levels of NT-proBNP, galectin-3, and ST2 in stratifying the prognosis of chronic heart failure (CHF) outpatients. In 315 CHF outpatients in stable clinical condition clinical and echocardiographic evaluations were performed. Routine chemistry and serum levels of NT-proBNP, galectin-3, and ST2 were also assessed. During a 12 month follow-up, cardiovascular death, and/or heart failure (HF) occurred in 64 patients. The presence of NT-proBNP, galectin-3, and ST2 were higher than the recommended cutoffs and were all associated with events at univariate Cox regression analysis, as well as in a multivariate analysis including the three biomarkers. When a score based on the number of biomarkers above the recommended cut-offs was used (in a range of 0-3), it was associated with events both with respect to the univariate (HR 2.96, 95% CI 2.21-3.95, p < 0.001, C-index 0.78) and the multivariate (HR 1.52, 95% CI 1.06-2.17, p: 0.023, C-index 0.87) analyses, after correction for the variables of a reference model. Our results suggest that an easy prognostic approach based on the combination of three biomarkers, although with partially-overlapping pathophysiological mechanisms, is able to identify patients with the highest risk of heart failure progression.
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Affiliation(s)
- Dario Grande
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Marta Leone
- Cardiology Unit, S.S. Annunziata Hospital, Via Bruno Francesco 1, 74123 Taranto, Italy.
| | - Caterina Rizzo
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Paola Terlizzese
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Giuseppe Parisi
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | | | - Tiziana Leopizzi
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Antonio Segreto
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Piero Guida
- Scientific Clinical Institutes Maugeri, I.R.C.C.S., Institute of Cassano delle Murge, Contrada Frà Diavolo 13, 70020Cassano delle Murge, Italy.
| | - Roberta Romito
- Emergency Cardiology Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Marco Matteo Ciccone
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Francesca Di Serio
- Clinic Pathology Unit, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Massimo Iacoviello
- Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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Malhotra R, Kashani KB, Macedo E, Kim J, Bouchard J, Wynn S, Li G, Ohno-Machado L, Mehta R. A risk prediction score for acute kidney injury in the intensive care unit. Nephrol Dial Transplant 2017; 32:814-822. [DOI: 10.1093/ndt/gfx026] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/28/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Kianoush B. Kashani
- Division of Nephrology and Hypertension and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Etienne Macedo
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jihoon Kim
- Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Josee Bouchard
- Service de Néphrologie, Département de médecine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Susan Wynn
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Guangxi Li
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Lucila Ohno-Machado
- Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Ravindra Mehta
- Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, San Diego, CA, USA
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Serum Cytokine Profile in Relation to the Severity of Coronary Artery Disease. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4013685. [PMID: 28349060 PMCID: PMC5352875 DOI: 10.1155/2017/4013685] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/09/2017] [Accepted: 02/12/2017] [Indexed: 11/25/2022]
Abstract
Objectives. To investigate the potential association of a set of serum cytokines with the severity of coronary artery disease (CAD). Methods. A total of 201 patients who underwent coronary angiography for chest discomfort were enrolled. The concentrations of serum IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, IL-9, and IL-17 were determined by xMAP multiplex technology. The CAD severity was assessed by Gensini score (GS). Results. The serum levels of TNF-α, IL-6, IL-9, IL-10, and IL-17 were significantly higher in high GS group (GS ≥ 38.5) than those in low GS group (GS < 38.5). Positive correlations were also found between these cytokines and the severity of CAD. After adjustment for other associated factors, three serum cytokines (IL-6, IL-9, and IL-17) and two clinical risk factors (creatinine and LDL-C) were identified as the independent predictors of increased severity of CAD. ROC curve analysis revealed that the logistic regression risk prediction model had a good performance on predicting CAD severity. Conclusions. Combinatorial analysis of serum cytokines (IL-6, IL-9, and IL-17) with clinical risk factors (creatinine and LDL-C) may contribute to the evaluation of the severity of CAD and may help guide the risk stratification of angina patients, especially in primary health facilities and in the catheter lab resource-limited settings.
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Clinical benefits of natriuretic peptides and galectin-3 are maintained in old dyspnoeic patients. Arch Gerontol Geriatr 2016; 68:33-38. [PMID: 27611369 DOI: 10.1016/j.archger.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute dyspnoea is the leading cause of unscheduled admission of elderly patients. Several biomarkers are used to diagnose acute heart failure (AHF) and assess prognosis of dyspnoeic patients, but their value in elderly patients is unclear. OBJECTIVE To compare diagnostic and prognostic performances of conventional and novel cardiovascular biomarkers in 2 age groups: young (<75 years old) vs. old (≥75 years old) dyspnoeic patients. DESIGN Prospective observational registry. SETTING Emergency department (ED). SUBJECTS Acutely dyspnoeic adult patients. METHODS Blood samples were collected at ED admission. The diagnostic value of 4 natriuretic peptides (BNP, proBNP, NT-proBNP, MR-proANP) for AHF was tested. We also assessed the prognostic value of same natriuretic peptides and of 3 novel cardiovascular biomarkers (galectin-3, sST2 and proenkephalin), using 1-year all-cause mortality as end-point. Diagnostic or prognostic performances are expressed as area under the receiveroperating characteristic curve (AUC) with 95% confidence interval. RESULTS Two hundred one acutely dyspnoeic patients were studied. AHF was the cause of dyspnoea in 57% of old and 44% of young patients, respectively. All 4 natriuretic peptides performed well in diagnosing AHF in both age groups (all AUC>0.7). BNP showed the best diagnostic performance in both old (AUC: 0.98 [0.97-1.00]) and young (AUC 0.98 [0.95-1.00]) patients. Galectin-3 showed the best prognostic performance in both old (AUC 0.74 [0.62-0.87]) and young patients (AUC 0.75 [0.56-0.94]). CONCLUSIONS BNP and galectin-3 show good clinical benefits in both oldand young acutely dyspnoeic patients.
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Wettersten N, Maisel AS. Biomarkers for Heart Failure: An Update for Practitioners of Internal Medicine. Am J Med 2016; 129:560-7. [PMID: 26844635 DOI: 10.1016/j.amjmed.2016.01.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 02/06/2023]
Abstract
Biomarkers have become an integral part of practicing medicine, especially in heart failure. The natriuretic peptides are commonly used in the evaluation of heart failure, but their role extends beyond diagnosis and includes risk stratification and management of heart failure patients. Newer biomarkers have arrived and are becoming part of routine care of heart failure patients. Both ST2 and high-sensitivity troponin have significant prognostic value for mortality, but also may assist in the titration of medical therapy. Procalcitonin can help guide appropriate antibiotic use in patients with heart failure. The ability to appropriately use and interpret these biomarkers is imperative to the care of heart failure patients, especially as these newer biomarkers become widely used.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla
| | - Alan S Maisel
- Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, La Jolla, Calif.
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Pickering JW, Endre ZH. The clinical utility of plasma neutrophil gelatinase-associated lipocalin in acute kidney injury. Blood Purif 2013; 35:295-302. [PMID: 23712081 DOI: 10.1159/000351542] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/24/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM Neutrophil gelatinase-associated lipocalin (NGAL) is derived from the distal tubule and is both reabsorbed and filtered and also shed into the urine after tubular injury. Plasma NGAL is unique amongst the candidate biomarkers of acute kidney injury (AKI) since elevated concentrations may reflect either a change in renal glomerular function or in structural tubular injury or both. In this study, we compared the performance of plasma NGAL in the diagnosis of functional changes and in the diagnosis of structural injury. METHODS Plasma and urine samples from 528 patients were collected on entry to an intensive care unit (ICU) as well as 12 and 24 h later. Plasma NGAL diagnostic performance was independently assessed for Functional-AKI and Structural-AKI. Functional-AKI was defined by changes in plasma creatinine, whereas Structural-AKI was defined by elevations in urinary NGAL. RESULTS On ICU entry, the area under the curve (AUC) for the diagnosis of Functional-AKI was 0.74 (95% CI: 0.69-0.79), and for Structural-AKI it was 0.79 (0.74-0.83). Plasma NGAL also predicted the need for dialysis (0.79; 0.66-0.81), but not for death. A principal component analysis demonstrated that the maximum plasma NGAL in 24 h reflected structural injury marginally more than functional changes. Plasma NGAL added value to an AKI diagnostic model comprising plasma creatinine, sepsis, age, and APACHE II score (integrated discrimination improvement: 0.073; 0.034-0.12). CONCLUSION Increased plasma NGAL reflects both decreased filtration and structural injury. For patients at a low calculated risk, the addition of NGAL reduced the risk, and for those at a higher risk, NGAL correctly assigned patients to even a higher risk.
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Affiliation(s)
- John W Pickering
- Christchurch Kidney Research Group, Department of Medicine, School of Medicine and Health Sciences, University of Otago Christchurch, Christchurch, New Zealand.
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de Haro C, Martin-Loeches I, Torrents E, Artigas A. Acute respiratory distress syndrome: prevention and early recognition. Ann Intensive Care 2013; 3:11. [PMID: 23617961 PMCID: PMC3639084 DOI: 10.1186/2110-5820-3-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/31/2013] [Indexed: 11/17/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). ARDS results in increased use of critical care resources and healthcare costs, yet the overall mortality associated with these conditions remains high. Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. To date, few strategies have shown clear benefits. One of the most important obstacles to preventive interventions is the difficulty of identifying patients likely to develop ARDS. Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. This review will discuss early identification of at-risk patients and the current prevention strategies.
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Affiliation(s)
- Candelaria de Haro
- Critical Care Centre, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Spain.
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LaFramboise WA, Dhir R, Kelly LA, Petrosko P, Krill-Burger JM, Sciulli CM, Lyons-Weiler MA, Chandran UR, Lomakin A, Masterson RV, Marroquin OC, Mulukutla SR, McNamara DM. Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography. BMC Med 2012; 10:157. [PMID: 23216991 PMCID: PMC3566965 DOI: 10.1186/1741-7015-10-157] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 12/05/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD) using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial. METHODS Serum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI) while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery). Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ≤ 1%) and Q value (P value for statistical significance adjusted to ≤ 0.01). RESULTS Significant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100), C-reactive protein (CRP), fibrinogen, vascular cell adhesion molecule 1 (VCAM-1), myeloperoxidase (MPO), resistin, osteopontin, interleukin (IL)-1β, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP) and decreased apolipoprotein A1 (APO-A1). Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity) while maintaining 95% sensitivity for patients requiring revascularization. Osteopontin (14 times) and resistin (10 times) were most frequently represented among these diagnostic signatures. The most efficacious protein signature in validation studies comprised osteopontin (OPN), resistin, matrix metalloproteinase 7 (MMP7) and interferon γ (IFNγ) as a four-marker panel while the addition of either CRP or adiponectin (ACRP-30) yielded comparable results in five protein signatures. CONCLUSIONS Proteins in the serum of CAD patients predominantly reflected (1) a positive acute phase, inflammatory response and (2) alterations in lipid metabolism, transport, peroxidation and accumulation. There were surprisingly few indicators of growth factor activation or extracellular matrix remodeling in the serum of CAD patients except for elevated OPN. These data suggest that many symptomatic patients without significant CAD could be identified by a targeted multiplex serum protein test without cardiac catheterization thereby eliminating exposure to ionizing radiation and decreasing the economic burden of angiographic testing for these patients.
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Affiliation(s)
- William A LaFramboise
- University of Pittsburgh, Department of Pathology, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
- University of Pittsburgh, Department of Biomedical Informatics, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Rajiv Dhir
- University of Pittsburgh, Department of Pathology, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
- University of Pittsburgh, Department of Biomedical Informatics, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Lori A Kelly
- University of Pittsburgh, Department of Pathology, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Patricia Petrosko
- University of Pittsburgh, Department of Pathology, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - John M Krill-Burger
- University of Pittsburgh, Department of Pathology, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Christin M Sciulli
- University of Pittsburgh, Department of Pathology, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Maureen A Lyons-Weiler
- University of Pittsburgh, Department of Pathology, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Uma R Chandran
- University of Pittsburgh, Department of Biomedical Informatics, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Aleksey Lomakin
- Materials Processing Center, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | | | - Oscar C Marroquin
- University of Pittsburgh, Division of Cardiology, Department of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- UPMC Heart and Vascular Institute, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, Pittsburgh PA, 15213, USA
| | - Suresh R Mulukutla
- University of Pittsburgh, Division of Cardiology, Department of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- UPMC Heart and Vascular Institute, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, Pittsburgh PA, 15213, USA
| | - Dennis M McNamara
- University of Pittsburgh, Division of Cardiology, Department of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- UPMC Heart and Vascular Institute, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Rogers GB, Hoffman LR, Johnson MW, Mayer-Hamblett N, Schwarze J, Carroll MP, Bruce KD. Using bacterial biomarkers to identify early indicators of cystic fibrosis pulmonary exacerbation onset. Expert Rev Mol Diagn 2011; 11:197-206. [PMID: 21405970 DOI: 10.1586/erm.10.117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute periods of pulmonary exacerbation are the single most important cause of morbidity in cystic fibrosis patients, and may be associated with a loss of lung function. Intervening prior to the onset of a substantially increased inflammatory response may limit the associated damage to the airways. While a number of biomarker assays based on inflammatory markers have been developed, providing useful and important measures of disease during these periods, such factors are typically only elevated once the process of exacerbation has been initiated. Identifying biomarkers that can predict the onset of pulmonary exacerbation at an early stage would provide an opportunity to intervene before the establishment of a substantial immune response, with major implications for the advancement of cystic fibrosis care. The precise triggers of pulmonary exacerbation remain to be determined; however, the majority of models relate to the activity of microbes present in the patient's lower airways of cystic fibrosis. Advances in diagnostic microbiology now allow for the examination of these complex systems at a level likely to identify factors on which biomarker assays can be based. In this article, we discuss key considerations in the design and testing of assays that could predict pulmonary exacerbations.
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Affiliation(s)
- Geraint B Rogers
- Molecular Microbiology Research Laboratory, Pharmaceutical Science Division, 150 Stamford Street, Franklin-Wilkins Building, King's College London, London, SE1 9NH, UK
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18
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Cross LJM, Matthay MA. Biomarkers in acute lung injury: insights into the pathogenesis of acute lung injury. Crit Care Clin 2011; 27:355-77. [PMID: 21440206 PMCID: PMC3073651 DOI: 10.1016/j.ccc.2010.12.005] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Studies of potential biomarkers of acute lung injury (ALI) have provided information relating to the pathophysiology of the mechanisms of lung injury and repair. The utility of biomarkers remains solely among research tools to investigate lung injury and repair mechanisms. Because of lack of sensitivity and specificity, they cannot be used in decision making in patients with ALI or acute respiratory distress syndrome. The authors reviewed known biomarkers in context of their major biologic activity. The continued interest in identifying and studying biomarkers is relevant, as it provides information regarding the mechanisms involved in lung injury and repair and how this may be helpful in identifying and designing future therapeutic targets and strategies and possibly identifying a sensitive and specific biomarker.
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Affiliation(s)
- L J Mark Cross
- Centre for Infection and Immunity, The Queen's University of Belfast, Room 01/014, Health Sciences Building, 97 Lisburn Road, Belfast, BT9 7BL, N Ireland
| | - Michael A Matthay
- Cardiovascular Research Institute, University of California, San Francisco, 505 Parnassus Ave, M-917, San Francisco, CA 94143-0624, California, USA
- Department of Medicine, Division of Pulmonary and Critical Care, and Department of Anaesthesia, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-2202, California, USA
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Guha M, Heier A, Price S, Bielenstein M, Caccese RG, Heathcote DI, Simpson TR, Stong DB, Bodes E. Assessment of Biomarkers of Drug-Induced Kidney Injury in Cynomolgus Monkeys Treated with a Triple Reuptake Inhibitor. Toxicol Sci 2011; 120:269-83. [DOI: 10.1093/toxsci/kfr013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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