Role of proenkephalin in the diagnosis of severe and subclinical acute kidney injury during the perioperative period of liver transplantation

Lima, Camila; Gorab, Daniella Lacerda; Fernandes, Carol Ribeiro; Macedo, Etienne

doi:10.1016/j.plabm.2022.e00278

Cited by 15 publications

(8 citation statements)

References 45 publications

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“…Although the relevant pathophysiology on the subject is currently unclear, this does not prevent the application of p-PENK levels to predict the prognoses of AKI patients, especially in the ICU. In addition, p-PENK level appears to be an independent predictor of kidney complications, as well as cardiovascular and liver-related diseases [ 23 ]. Quantified patient p-PENK has been shown to predict postoperative AKI and in-hospital mortality following aortic repair.…”

Section: Discussionmentioning

confidence: 99%

Plasma proenkephalin and neutrophil gelatinase-associated lipocalin predict mortality in ICU patients with acute kidney injury

Zhang,

Yang,

Zhu

et al. 2024

BMC Nephrol

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Background Acute kidney injury (AKI) is a common complication in patients admitted to intensive care unit (ICU) and mortality rates for this condition are high. To reduce the high incidence of short-term mortality, reliable prognostic indicators are required to facilitate early diagnosis and treatment of AKI. We assessed the ability of plasma proenkephalin (p‑PENK) and plasma neutrophil gelatinase-associated lipocalin (p‑NGAL) to predict 28-day mortality in AKI patients in intensive care. Methods This prospective study, carried out between January 2019 and December 2019, comprised 150 patients (100 male) diagnosed with AKI after excluding 20 patients discharged within 24 h and those with missing hospitalization data. Blood samples were collected to determine admission p-PENK and p-NGAL levels. The study outcome was 28‑day mortality. Results The mean patient age was 68 years (female, 33%). The average P‑PENK and p‑NGAL levels were 0.24 ng/µL and 223.70 ng/mL, respectively. P‑PENK levels >0.36 ng/µL and p‑NGAL levels >230.30 ng/mL were used as critical values to reliably indicate 28‑day mortality for patients with AKI (adjusted hazard ratios 0.785 [95% confidence interval 0.706–0.865, P<0.001] and 0.700 [95% confidence interval 0.611–0.789, P<0.001], respectively). This association was significant for mortality in patients in intensive care with AKI. Baseline p-PENK (0.36 ng/µL) and p-NGAL (230.30 ng/mL) levels and their respective cut-off values showed clinical value in predicting 28-day mortality. Conclusion Serum PENK and NGAL levels, when used in conjunction, improved the accuracy of predicting 28-day mortality in patients with AKI while retaining sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Plasma proenkephalin and neutrophil gelatinase-associated lipocalin predict mortality in ICU patients with acute kidney injury

Zhang,

Yang,

Zhu

et al. 2024

BMC Nephrol

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“…Penkid levels raised with increasing severity of sepsis in Kim et al (2017) cohort study of 167 patients, with a cut-off value of 154.5 pmol/L with an AUC of 0.73 for the diagnosis of AKI, and Penkid was found to be significantly higher in patients with severe AKI in Camila Lima et al, 2022 study before liver transplantation. Patients had significantly higher AUC of 0.69 (CI 0.54–0.83), cut-off value of 55.30 pmol/L, sensitivity of 0.86, specificity of 0.52 and accuracy of 0.75, and at 48 h after liver transplantation, the performance of Penkid in determining severe AKI was unchanged with an AUC of 0.83 (CI 0.72–0.94), a cut-off value of 119.05 pmol/L, a sensitivity of 0.81, a specificity of 0.90 and an accuracy of 0.84 ( Lima et al, 2022 ). Moreover, Penkid has shown promising results in monitoring renal function in acute patients, especially those with sepsis.…”

Section: Other Novel Biomarkersmentioning

confidence: 98%

“…Penkid has a long in vivo half-life, is stable after collection, is not easily catabolized, and its levels are unaffected by age or gender. Furthermore, it is not a plasma-bound protein and is only filtered solely in the glomerulus ( Lima et al, 2022 ). Penkid plasma concentrations have been observed to correlate positively and inversely with measured glomerular filtration rate (GFR) ( Beunders et al, 2020 ), and high Penkid values appear to represent a more important risk status than low eGFR values, as Penkid predicts 28-days mortality but eGFR does not, and it is therefore considered to be a biomarker of glomerular filtration injury or a biomarker of renal function.…”

Section: Other Novel Biomarkersmentioning

confidence: 99%

Advances in the study of subclinical AKI biomarkers

2022

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Acute kidney injury (AKI) is a prevalent and serious illness in all clinical departments, with a high morbidity and death rate, particularly in intensive care units, where prevention and treatment are crucial. As a result, active prevention, early detection, and timely intervention for acute kidney injury are critical. The current diagnostic criteria for acute kidney injury are an increase in serum creatinine concentration and/or a decrease in urine output, although creatinine and urine output merely reflect changes in kidney function, and AKI suggests injury or damage, but not necessarily dysfunction. The human kidney plays a crucial functional reserve role, and dysfunction is only visible when more than half of the renal mass is impaired. Tubular damage markers can be used to detect AKI before filtration function is lost, and new biomarkers have shown a new subset of AKI patients known as “subclinical AKI.” Furthermore, creatinine and urine volume are only marginally effective for detecting subclinical AKI. As a result, the search for new biomarkers not only identifies deterioration of renal function but also allows for the early detection of structural kidney damage. Several biomarkers have been identified and validated. This study discusses some of the most promising novel biomarkers of AKI, including CysC, NGAL, KIM-1, lL-18, L-FABP, IGFBP7, TIMP-2, Clusterin, and Penkid. We examine their performance in the diagnosis of subclinical AKI, limitations, and future clinical practice directions.

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“…60 Fewer studies have been performed in surgical cohorts although performance in patients undergoing cardiac and transplantation surgery has been reported. 61,62 Damage Biomarkers…”

Section: Functional Biomarkersmentioning

confidence: 99%

Prognostic Biomarkers and AKI: Potential to Enhance the Identification of Post-Operative Patients at Risk of Loss of Renal Function

Singh,

Watchorn,

Zarbock

et al. 2024

RRU

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Acute kidney injury (AKI) is a common complication after surgery and the more complex the surgery, the greater the risk. During surgery, patients are exposed to a combination of factors all of which are associated with the development of AKI. These include hypotension and hypovolaemia, sepsis, systemic inflammation, the use of nephrotoxic agents, tissue injury, the infusion of blood or blood products, ischaemia, oxidative stress and reperfusion injury. Given the risks of AKI, it would seem logical to conclude that early identification of patients at risk of AKI would translate into benefit. The conventional markers of AKI, namely serum creatinine and urine output are the mainstay of defining chronic kidney disease but are less suited to the acute phase. Such concerns are compounded in surgical patients given they often have significantly reduced mobility, suboptimal levels of nutrition and reduced muscle bulk. Many patients may also have misleadingly low serum creatinine and high urine output due to aggressive fluid resuscitation, particularly in intensive care units. Over the last two decades, considerable information has accrued with regard to the performance of what was termed “novel” biomarkers of AKI, and here, we discuss the most examined molecules and performance in surgical settings. We also discuss the application of biomarkers to guide patients’ postoperative care.

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Role of proenkephalin in the diagnosis of severe and subclinical acute kidney injury during the perioperative period of liver transplantation

Cited by 15 publications

References 45 publications

Plasma proenkephalin and neutrophil gelatinase-associated lipocalin predict mortality in ICU patients with acute kidney injury

Plasma proenkephalin and neutrophil gelatinase-associated lipocalin predict mortality in ICU patients with acute kidney injury

Advances in the study of subclinical AKI biomarkers

Prognostic Biomarkers and AKI: Potential to Enhance the Identification of Post-Operative Patients at Risk of Loss of Renal Function

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