Evaluation of Microal buminuria and Serum Tnf Α In Patients with Sepsis and Their Correlation with Disease Severity

Abstract

Introduction: Diffuse endothelial dysfunction in sepsis leads to an increase in systemic capillary permeability, the renal component manifesting as micro albuminuria. The degree of microalbuminuria correlates with the severity of acute insult, the quantification of which may serve to predict sepsis and mortality in critically ill patients. Objectives: 1. To evaluate the degree of microalbuminuria and correlate with severity of sepsis. 2. To evaluate levels of TNFαand severity of sepsis. 3. To correlate degree of microalbuminuria with levels of TNF α in patients with sepsis and its outcome. Methodology: The present study is prospective non interventional study. Patients admitted to medicine ward and ICU staying more than 24 hrs at S.C.B medical college, Cuttack are included in the study, during period of Sept'2011 - Sept'2012. 1. Urine samples were collected within 6 hrs of admission and again at 24 hrs. 2. Urinary microalbumin assay by microalbumin kit (pyrogallol red immunobiometric method) 3.Urinary creatinine estimation by creatinine kit (mod jaffe's kinetic method) 4. Urinary Albumin Creatinine Ratio (ACR) 30-300 mg/gm is microalbuminuria. 5. TNF α is estimated in patients with sepsis by ELISA (bioplex). Results: Patients (n=75) were classified into sepsis,severe sepsis,septic shock and MODS according to American College of chest physician society of critical care consensus. ACR in sepsis group was significantly higher than control group (P=0.0001). Among sepsis cases ACR has a positive correlation with APACHE ІІ score and also distinguishes between survivors and nonsurvivors (p=0.001). ACR could easily distinguish patients of MODS from sepsis (p=0.03) and septic shock from sepsis(p=0.007). Values of TNFα can distinguish survivors from nonsurvivors (p=0.04) and TNFα also distinguishes patients of sepsis from septic shock (p=0.002). Conclusion: Microalbuminuria has a good diagnostic and prognostic significance in sepsis as compared to APACHE ІІ score and TNFα.