Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock
Jäntti, Toni (Helsinki University Hospital (Finlàndia))
Tarvasmäki, Tuukka (Helsinki University Hospital (Finlàndia))
Harjola, Veli-Pekka (Helsinki University Hospital (Finlàndia))
Pulkki, Kari (Helsinki University Hospital (Finlàndia))
Turkia, Heidi (Helsinki University Hospital (Finlàndia))
Sabell, Tuija (Helsinki University Hospital (Finlàndia))
Tolppanen, Heli (Helsinki University Hospital (Finlàndia))
Jurkko, Raija (Helsinki University Hospital (Finlàndia))
Hongisto, Mari (Helsinki University Hospital (Finlàndia))
Kataja, Anu (Helsinki University Hospital (Finlàndia))
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Silva-Cardoso, Jose (University of Porto)
Banaszewski, Marek (National Institute of Cardiology, Warsaw, Poland)
DiSomma, Salvatore (University of Rome Sapienza)
Mebazaa, Alexandre (University Paris Diderot)
Haapio, Mikko (Helsinki University Hospital (Finlàndia))
Lassus, Johan (Helsinki University Hospital (Finlàndia))
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Acute kidney injury (AKI) is a frequent form of organ injury in cardiogenic shock. However, data on AKI markers such as plasma proenkephalin (P-PENK) and neutrophil gelatinase-associated lipocalin (P-NGAL) in cardiogenic shock populations are lacking. The objective of this study was to assess the ability of P-PENK and P-NGAL to predict acute kidney injury and mortality in cardiogenic shock. P-PENK and P-NGAL were measured at different time points between baseline and 48 h in 154 patients from the prospective CardShock study. The outcomes assessed were AKI defined by an increase in creatinine within 48 h and all-cause 90-day mortality. Mean age was 66 years and 26% were women. Baseline levels of P-PENK and P-NGAL (median [interquartile range]) were 99 (71-150) pmol/mL and 138 (84-214) ng/mL. P-PENK > 84. 8 pmol/mL and P-NGAL > 104 ng/mL at baseline were identified as optimal cut-offs for AKI prediction and independently associated with AKI (adjusted HRs 2. 2 [95% CI 1. 1-4. 4, p = 0. 03] and 2. 8 [95% CI 1. 2-6. 5, p = 0. 01], respectively). P-PENK and P-NGAL levels at baseline were also associated with 90-day mortality. For patients with oliguria < 0. 5 mL/kg/h for > 6 h before study enrollment, 90-day mortality differed significantly between patients with low and high P-PENK/P-NGAL at baseline (5% vs. 68%, p < 0. 001). However, the biomarkers provided best discrimination for mortality when measured at 24 h. Identified cut-offs of P-PENK > 105. 7 pmol/L and P-NGAL > 151 ng/mL had unadjusted hazard ratios of 5. 6 (95% CI 3. 1-10. 7, p < 0. 001) and 5. 2 (95% CI 2. 8-9. 8, p < 0. 001) for 90-day mortality. The association remained significant despite adjustments with AKI and two risk scores for mortality in cardiogenic shock. High levels of P-PENK and P-NGAL at baseline were independently associated with AKI in cardiogenic shock patients. Furthermore, oliguria before study inclusion was associated with worse outcomes only if combined with high baseline levels of P-PENK or P-NGAL. High levels of both P-PENK and P-NGAL at 24 h were found to be strong and independent predictors of 90-day mortality. Trial registration : NCT01374867 at , registered 16 Jun 2011-retrospectively registered.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cardiogenic shock ; Acute kidney injury ; AKI ; Mortality ; Prognosis ; Proenkephalin ; PENK ; NGAL
Publicat a:	Annals of Intensive Care, Vol. 11 (february 2021) , ISSN 2110-5820

DOI: 10.1186/s13613-021-00814-8
PMID: 33547528

15 p, 1.8 MB

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