Use of Biomarkers to Identify Acute Kidney Injury to Help Detect Sepsis in Patients With Infection
Kellum, John A. (Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Gunnerson, Kyle J. (Departments of Emergency Medicine/Critical Care, Anesthesiology, Internal Medicine, Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, MI)
Honore, Patrick M. (Department of Intensive Care Medicine, Brugmann University Hospital, Brussels, Belgium)
Kampf, J. Patrick (Astute Medical, Inc. (a bioMérieux company), San Diego, CA)
Kwan, Thomas (Astute Medical, Inc. (a bioMérieux company), San Diego, CA)
McPherson, Paul (Astute Medical, Inc. (a bioMérieux company), San Diego, CA)
Nguyen, H. Bryant (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA)
Rimmelé, Thomas (Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France)
Shapiro, Nathan I. (Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA)
Shi, Jing (Walker BioSciences, Carlsbad, CA)
Vincent, Jean-Louis (Université Libre de Bruxelles)
Chawla, Lakhmir S. (Department of Medicine, Veterans Affairs Medical Center, San Diego, CA)
Universitat Autònoma de Barcelona

Fecha:	2021
Resumen:	Supplemental Digital Content is available in the text. Retrospective, international, Sapphire study. Academic Medical Center. Adults admitted to the ICU without evidence of acute kidney injury at time of enrollment. None. We stratified patients enrolled in the Sapphire study into three groups-those with a clinical diagnosis of sepsis (n = 216), those with infection without sepsis (n = 120), and those without infection (n = 387) at enrollment. We then examined 30-day mortality stratified by acute kidney injury within each group. Finally, we determined the operating characteristics for kidney stress markers (tissue inhibitor of metalloproteinases-2) × (insulin-like growth factor binding protein 7) for prediction of acute kidney injury as a sepsis-defining organ failure in patients with infection without a clinical diagnosis of sepsis at enrollment. Combining all groups, 30-day mortality was 23% for patients who developed stage 2-3 acute kidney injury within the first 3 days compared with 14% without stage 2-3 acute kidney injury. However, this difference was greatest in the infection without sepsis group (34% vs 11%; odds ratio, 4. 09; 95% CI, 1. 53-11. 12; p = 0. 005). Using a (tissue inhibitor of metalloproteinases-2) × (insulin-like growth factor binding protein 7) cutoff of 2. 0 units, 14 patients (11. 7%), in the infection/no sepsis group, tested positive of which 10 (71. 4%) developed stage 2-3 acute kidney injury. The positive test result occurred a median of 19 hours (interquartile range, 0. 8-34. 0 hr) before acute kidney injury manifested by serum creatinine or urine output. Similar results were obtained using a cutoff of 1. 0 for any stage of acute kidney injury. Use of the urinary (tissue inhibitor of metalloproteinases-2) × (insulin-like growth factor binding protein 7) test could identify acute kidney injury in patients with infection, possibly helping to detect sepsis, nearly a day before acute kidney injury is apparent by clinical criteria.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Acute kidney injury ; Insulin-like growth factor binding protein 7 ; Tissue inhibitor of metalloproteinases-2
Publicado en:	Critical Care Medicine, Vol. 49 (january 2021) , p. e360-e368, ISSN 1530-0293

DOI: 10.1097/CCM.0000000000004845
PMID: 33566467

9 p, 1.0 MB

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