Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients

Chun, Kayeong; Chung, Wookyung; Kim, Ae Jin; Kim, Hyun‐Sook; Ro, Han; Chang, Jae Hyun; Lee, Hyun Hee; Jung, Ji Yong

doi:10.1038/s41598-019-41291-1

Cited by 37 publications

(43 citation statements)

References 35 publications

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“…Therefore, combining the results of biomarkers involved in different steps of disease process may be helpful in the prediction and assessment of the risk. The [TIMP-2] × [IGFBP7] product is known to be a biomarker of kidney stress in multiple settings [18], while PCT is recognized as a suitable marker for sepsis (or infection) diagnosis and has recently been associated with AKI (contrast-induced AKI [19] and pancreatitisassociated AKI [20] and critically ill patients [7]).…”

Section: Discussionmentioning

confidence: 99%

“…Literature proved PCT to be a strong marker of infection and sepsis and recently PCT have been significantly associated with subsequent AKI development in critically ill patients [7]. Despite sepsis, other noninfective conditions, such as surgery, trauma, burn, pancreatitis, renal dysfunction can also increase PCT levels [28].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, procalcitonin (PCT), a widely used biomarker for sepsis diagnosis and management, showed a significant association with AKI development [6]. Despite this association, the usefulness of adding PCT levels to existing models for predicting the occurrence of AKI in critically ill patients is still not clear [7]. Nevertheless, a combination of kidney-specific and non-kidney-specific biomarkers may contribute to early identification of AKI and stratification of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Godi

Rosa

Martino

et al. 2020

Ann. Intensive Care

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Background: Biomarkers can play a critical role by facilitating diagnosis and stratification of disease, as well as assessment or prediction of disease severity. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 product ([TIMP-2] × [IGFBP7]) predict the development and progression of AKI and recently procalcitonin (PCT), a widely used biomarker for sepsis diagnosis and management, has been associated with AKI occurrence in ICU patients. To assess combinations of [TIMP-2] × [IGFBP7] and PCT results for prediction and risk stratification of short-term outcomes in septic and non-septic patients, a retrospective cohort analysis of critically ill patients was performed in a multidisciplinary ICU. ROC curve analysis was used in order to evaluate predictive performance of combined results of [TIMP-2] × [IGFBP7] and PCT at the time of admission for AKI development. To verify the utility of adding [TIMP-2] × [IGFBP7] and PCT results for risk assessment, we evaluated the predictive value of having a singlemarker positivity compared to a double-marker positivity using the widely used cutoff of 0.3 (ng/mL) 2 /1000 for [TIMP-2] × [IGFBP7] and 0.5 μg/L for PCT. Risk assessment for AKI occurrence within 48 h, acute kidney disease (AKD) and mortality at 7 days was performed by logistic/Cox regression analysis. Results: 433 patients were analysed, of whom 168 had AKI within 48 h (93 septic and 65 non-septic patients). Combination of [TIMP-2] × [IGFBP7] and PCT showed a good predictive ability for AKI occurrence (AUC 0.81, 95% CI 0.77-0.86, p < 0.001, Sens 78%, Spec 73%). Combinations of biomarkers increased the odd ratios (OR) considerably. A single-marker positivity showed a fourfold risk increase, while the double-marker positivity a 26-fold risk increase for AKI occurrence. Moreover, the double-marker positivity showed an elevated risk for AKD at 7 days in non-septic patients (OR 15.9, 95% CI 3,21-73,57, p < 0.001) and for mortality within 7 days in septic patients (HR 4.1, 95% CI 1.4-11.8, p = 0.001). Conclusions: Although combining the results of [TIMP-2] × [IGFBP7] and PCT may be a useful tool to identify and stratify ICU patients at high risk for septic AKI and short-term adverse outcomes, data should be confirmed in a large prospective study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Godi

Rosa

Martino

et al. 2020

Ann. Intensive Care

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show abstract

“…Acute kidney injury (AKI) is a common but complex disorder characterized by a rapid deterioration of kidney function. AKI affects about 2 to 7% of hospitalized patients and 13 to 78% of critically ill patients [ 1 , 2 , 3 , 4 ], with high morbidity and mortality [ 5 ]. Over the decades, advancements in therapies for AKI have been limited, and the prognoses in AKI patients remain unsatisfactory [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients

Huang

Lai

Shiao

2020

JCM

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It is unclear whether serum procalcitonin (PCT) levels rise in patients with acute kidney injury (AKI), and it is also unclear whether the elevation of PCT levels in this setting is independent of the existence of infection and impaired renal clearance. We conducted a retrospective study in a regional teaching hospital in Taiwan to evaluate the AKI-predictive ability of serum PCT among critically ill patients. We enrolled 330 patients (mean age, 70.5 ± 16.4 years; 57.0% men) who were admitted to the intensive care unit (ICU) from 1 July 2016, to 31 December 2016, and who had serum PCT measurement performed within 24 h after ICU admission. We used the generalized additive model and generalized linear model to evaluate the association of serum PCT levels and renal function variables. In addition, we used the multivariate logistic regression method to demonstrate serum PCT level as an independent predictor of AKI in both the non-infected patients (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.12–1.71, p = 0.003) and the infected patients (OR = 1.23, 95% CI = 1.03–1.46, p = 0.020). In conclusion, serum PCT level at ICU admission is an independent predictor of developing AKI irrespective of infection among critically ill patients.

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“…Apart from cytotoxicity and inflammation, increased PCT level has also been reported to be associated with increased creatinine and decreased glomerular filtration rate (35)(36)(37). And higher level of PCT was observed in AKI patients compared to non-AKI patients (38,39). Based on those findings, PCT level is expected to exhibit an approximately linear relationship with AKI development and increased PCT level in blood is expected to be associated with higher risk of AKI in patients.…”

Section: Discussionmentioning

confidence: 90%

Association between procalcitonin and acute kidney injury in patients with septic shock: A case-control study

et al. 2020

Preprint

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Objective This study aims to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by sepsis shock.Methods A case-control study was designed which included patients that admitted in intensive care unit (ICU) between January 2015 and October 2018. The worst values of biochemical parameters in the first 48 hours from septic shock admission to ICU were evaluated. According to KDIGO guideline, these patients were divided into AKI and non-AKI groups.Results Of 1631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients with AKI. Multiple logistic regression results showed that PCT (OR=1.017, 95% CI 1.009- 1.025, P<0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/ml, and with a sensitivity 63%, specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25mol/L and 120 mol/L (OR 0.963, 95% CI 0.929-0.999; P= 0.042). The AKI increased with the elevation of PCT when PCT was either less than 25mol/L (OR 1.077, 95% CI 1.022-1.136; P= 0.006) or more than 120mol/L (OR 1.042, 95% CI 1.009-1.076; P= 0.013). Moreover, the PCT level was significant higher in AKI group only in female patients with age under 75(P=0.001).Conclusions Our data revealed a nonlinear relationship between PCT in 48 hours admission to ICU and AKI in septic shock patients and PCT could be used as a biomarker of AKI only in female patients under 75 years with sepsis shock.

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Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients

Cited by 37 publications

References 35 publications

Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients

Association between procalcitonin and acute kidney injury in patients with septic shock: A case-control study

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