1
|
Frigyesi A, Boström L, Lengquist M, Johnsson P, Lundberg OHM, Spångfors M, Annborn M, Cronberg T, Nielsen N, Levin H, Friberg H. Plasma proenkephalin A 119-159 on intensive care unit admission is a predictor of organ failure and 30-day mortality. Intensive Care Med Exp 2021; 9:36. [PMID: 34278538 PMCID: PMC8286914 DOI: 10.1186/s40635-021-00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proenkephalin A 119-159 (penKid) has been suggested as a marker of renal failure and poor outcome. We aimed to investigate the association of penKid on ICU admission with organ dysfunction and mortality in a mixed ICU population. In this retrospective, observational study, admission penKid levels from prospectively collected blood samples of consecutive patients admitted to four Swedish ICUs were analysed. The association of penKid with day-two sequential organ failure assessment (SOFA) scores and 30-day mortality was investigated using (ordinal) logistic regression. The predictive power of penKid for 30-day mortality and dialysis was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Of 1978 included patients, 632 fulfilled the sepsis 3-criteria, 190 had a cardiac arrest, and 157 had experienced trauma. Admission penKid was positively associated with 30-day mortality with an odds ratio of 1.95 (95% confidence interval 1.75-2.18, p < 0.001), and predicted 30-day mortality in the entire ICU population with an AUC of 0.71 (95% confidence interval 0.68-0.73) as well as in the sepsis, cardiac arrest and trauma subgroups (AUCs of 0.61-0.84). Correction for admission plasma creatinine revealed that penKid correlated with neurological dysfunction. CONCLUSION Plasma penKid on ICU admission is associated with day-two organ dysfunction and predictive of 30-day mortality in a mixed ICU-population, as well as in sepsis, cardiac arrest and trauma subgroups. In addition to being a marker of renal dysfunction, plasma penKid is associated with neurologic dysfunction in the entire ICU population, and cardiovascular dysfunction in sepsis.
Collapse
Affiliation(s)
- Attila Frigyesi
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden.
- Skåne University Hospital, Intensive and Perioperative Care, 22185, Lund, Sweden.
| | - Lisa Boström
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, 22185, Lund, Sweden
| | - Maria Lengquist
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, 22185, Lund, Sweden
| | - Patrik Johnsson
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, 21428, Malmö, Sweden
| | - Oscar H M Lundberg
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, 21428, Malmö, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Kristianstad Central Hospital, Anaesthesia and Intensive Care, 29185, Kristianstad, Sweden
| | - Martin Annborn
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Helsingborg Hospital, Anaesthesia and Intensive Care, 25187, Helsingborg, Sweden
| | - Tobias Cronberg
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Skåne University Hospital, Department of Neurology, 22185, Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Helsingborg Hospital, Anaesthesia and Intensive Care, 25187, Helsingborg, Sweden
| | - Helena Levin
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Skåne University Hospital, Research and Education, 22185, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, 22185, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, 21428, Malmö, Sweden
| |
Collapse
|
2
|
Thorgeirsdóttir B, Levin H, Spångfors M, Annborn M, Cronberg T, Nielsen N, Lybeck A, Friberg H, Frigyesi A. Plasma proenkephalin A 119-159 and dipeptidyl peptidase 3 on admission after cardiac arrest help predict long-term neurological outcome. Resuscitation 2021; 163:108-115. [PMID: 33930500 DOI: 10.1016/j.resuscitation.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/20/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND A large proportion of adult survivors of cardiac arrest have a poor neurological outcome. Guidelines recommend multimodal neuro-prognostication no earlier than 72-96 h after cardiac arrest. There is great interest in earlier prognostic markers, including very early markers at admission. The novel blood biomarkers proenkephalin A 119-159 (penKid), bioactive adrenomedullin (bio-ADM) and circulating dipeptidyl peptidase 3 (cDPP3) have not been previously investigated for the early prognosis of cardiac arrest survivors. METHODS This multicentre observational study included adult survivors of cardiac arrest admitted to intensive care at four Swedish intensive care units (ICUs) during 2016. Blood samples were collected at ICU admission and batch analysed. The association between admission plasma penKid, bio-ADM and cDPP3 and poor long-term neurological outcome, according to the Cerebral Performance Category (CPC) scale, was assessed by binary logistic regression. Their prognostic performance was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 190 patients were included, of which 136 patients had suffered out-of-hospital and 54 patients in-hospital cardiac arrest. Poor long-term neurological outcome was associated with elevated admission plasma concentrations of penKid and cDPP3, but not with bio-ADM. The association for penKid, but not for cDPP3, remained after adjusting for clinical cardiac arrest variables with prognostic value (time to return of spontaneous circulation (ROSC), initial rhythm, admission Glasgow coma scale (GCS) motor score and absence of pupillary reflexes). The prognostic performance of above mentioned clinical cardiac arrest variables alone was very good with an AUC of 0.90 (95% confidence interval, CI, 0.86-0.95), but improved further with the addition of penKid resulting in an AUC of 0.93 (95% CI 0.89-0.97, p < 0.026). Plasma penKid and cDPP3 alone provided moderate long-term prognostic information with AUCs of 0.70 and 0.71, respectively. CONCLUSION After cardiac arrest, admission plasma levels of penKid and cDPP3, but not bio-ADM, predicted long-term neurological outcome. When added to clinical cardiac arrest variables, penKid further improved prognostic performance.
Collapse
Affiliation(s)
- Bergthóra Thorgeirsdóttir
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Intensive and Perioperative Care, SE-21428 Malmö, Sweden
| | - Helena Levin
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Research and Education, SE-22185 Lund, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Kristianstad Central Hospital, Anaesthesia and Intensive Care, SE-29185 Kristianstad, Sweden
| | - Martin Annborn
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Helsingborg Hospital, Anaesthesia and Intensive Care, SE-25187 Helsingborg, Sweden
| | - Tobias Cronberg
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Department of Neurology, SE-22185 Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Helsingborg Hospital, Anaesthesia and Intensive Care, SE-25187 Helsingborg, Sweden
| | - Anna Lybeck
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Intensive and Perioperative Care, SE-22185 Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Intensive and Perioperative Care, SE-21428 Malmö, Sweden
| | - Attila Frigyesi
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-22185 Lund, Sweden; Skåne University Hospital, Intensive and Perioperative Care, SE-22185 Lund, Sweden.
| |
Collapse
|
3
|
Gruber P, Fluri F, Schweizer J, Luft A, Müller B, Christ-Crain M, Katan M. Proenkephalin A Adds No Incremental Prognostic Value After Acute Ischemic Stroke. Clin Appl Thromb Hemost 2020; 26:1076029619895318. [PMID: 31973568 PMCID: PMC7098249 DOI: 10.1177/1076029619895318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The aim of this study was to confirm previous observations that proenkephalin A (PENK-A) may serve as prognostic marker in the setting of acute ischemic stroke in a large stroke cohort. Methods: The plasma concentration of PENK-A was measured within 72 hours of symptom onset in 320 consecutively enrolled patients with stroke. The primary outcome measures were unfavorable functional outcome (modified Rankin Scale score 0-2 vs 3-6) and mortality within 90 days. Logistic and cox proportional regression analyses were fitted to estimate odds ratios (ORs), hazard ratios (HRs) and 95% confidence intervals (CIs), respectively, for the association between PENK-A and the primary outcome measures. Results: After adjusting for demographic and vascular risk factors, PENK-A was neither independently associated with functional outcome (OR: 1.29, 95% CI: 0.16-10.35) nor mortality (HR: 1.02, 95% CI: 0.14-7.33). Conclusion: Among patients with acute stroke, PENK-A does not serve as an independent prognostic marker in this external validation cohort.
Collapse
Affiliation(s)
- Philipp Gruber
- Department of Neuroradiology, Cantonal Hospital Aarau, Switzerland.,Department of Neurology, University Hospital of Zurich, Switzerland
| | - Felix Fluri
- Department of Neurology, University Hospital of Würzburg, Germany.,Department of Neurology, Cantonal Hospital of St Gallen, Switzerland
| | | | - Andreas Luft
- Department of Neurology, University Hospital of Zurich, Switzerland
| | - Beat Müller
- Medical University Clinic, Cantonal Hospital Aarau, Switzerland
| | | | - Mira Katan
- Department of Neurology, University Hospital of Zurich, Switzerland
| |
Collapse
|
4
|
Abstract
This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants). This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants).
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
| |
Collapse
|