Acute Changes in Serum Creatinine and Kinetic Glomerular Filtration Rate Estimation in Early Phase of Acute Pancreatitis

Abstract

In patients with acutely changing kidney function, equations used to estimate glomerular filtration rate (eGFR) must be adjusted for dynamic changes in the concentrations of filtration markers (kinetic eGFR, KeGFR). The aim of our study was to evaluate serum creatinine-based KeGFR in patients in the early phase of acute pancreatitis (AP) as a marker of changing renal function and as a predictor of AP severity. We retrospectively calculated KeGFR on day 2 and 3 of the hospital stay in a group of 147 adult patients admitted within 24 h from the onset of AP symptoms and treated in two secondary-care hospitals. In 34 (23%) patients, changes in serum creatinine during days 1–3 of the hospital stay exceeded 26.5 µmol/L; KeGFR values almost completely differentiated those with increasing and decreasing serum creatinine (area under receiver operating characteristic curve, AUROC: 0.990 on day 3). In twelve (8%) patients, renal failure was diagnosed during the first three days of the hospital stay according to the modified Marshall scoring system, which was associated with significantly lower KeGFR values. KeGFR offered good diagnostic accuracy for renal failure (area under receiver operating characteristic—AUROC: 0.942 and 0.950 on days 2 and 3). Fourteen (10%) patients developed severe AP. KeGFR enabled prediction of severe AP with moderate diagnostic accuracy (AUROC: 0.788 and 0.769 on days 2 and 3), independently of age, sex, comorbidities and study center. Lower KeGFR values were significantly associated with mortality. Significant dynamic changes in renal function are common in the early phase of AP. KeGFR may be useful in the assessment of kidney function in AP and the prediction of AP severity.

Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study.

“…This is further con rmed by the negative interaction found between NLR and eGFR; indeed, whereas both increasing NLR and decreasing eGFR were signi cantly associated with mortality in fully-adjusted models, their prognostic interaction was negative and multiplicative in both categorical and continuous models. More in detail, patients with eGFR ≥ 45 ml/min/1.73 m2 and high NLR shared a signi cant higher risk of death compared to those with eGFR < 45 and normal NLR, thus underlining the importance of considering NLR in addition to eGFR in stratifying the prognosis of older patients in the acute care setting, where the evaluation of eGFR only could be biased by rapid changes of serum creatinine during hospital stay (32,33).…”

Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study

“…This is further confirmed by the negative interaction found between NLR and eGFR; indeed, whereas both increasing NLR and decreasing eGFR were significantly associated with mortality in fully-adjusted models, their prognostic interaction was negative and multiplicative in both categorical and continuous models. More in detail, patients with eGFR ≥ 45 ml/min/1.73 m 2 and high NLR shared a significant higher risk of death compared to those with eGFR < 45 and normal NLR, thus underlining the importance of considering NLR in addition to eGFR in stratifying the prognosis of older patients in the acute care setting, where the evaluation of eGFR only could be biased by rapid changes of serum creatinine during hospital stay [34,35].…”