Abstract
ABSTRACTObjective:To investigate the relation between the need for red blood cell transfusion and serum levels of soluble-Fas, erythropoietin and inflammatory cytokines in critically ill patients with and without acute kidney injury.Methods:We studied critically ill patients with acute kidney injury (n=30) and without acute kidney injury (n=13), end-stage renal disease patients on hemodialysis (n=25) and healthy subjects (n=21). Serum levels of soluble-Fas, erythropoietin, interleukin 6, interleukin 10, iron status, hemoglobin and hematocrit concentration were analyzed in all groups. The association between these variables in critically ill patients was investigated.Results:Critically ill patients (acute kidney injury and non-acute kidney injury patients) had higher serum levels of erythropoietin than the other groups. Hemoglobin concentration was lower in the acute kidney injury patients than in other groups. Serum soluble-Fas levels were higher in acute kidney injury and end-stage renal disease patients. Critically ill patients requiring red blood cell transfusions had higher serum levels of soluble-Fas (5,906±2,047 and 1,920±1,060; p<0.001), interleukin 6 (518±537 and 255+502; p=0.02) and interleukin 10 (35.8±30.7 and 18.5±10.9; p=0.02), better iron status and higher mortality rates in the first 28 days in intensive care unit. Serum soluble-Fas levels were independently associated with the number of red blood cell units transfused (p=0.02). Serum soluble-Fas behaved as an independent predictor of the need for red blood cell transfusion in critically ill patients (p=0.01).Conclusions:Serum soluble-Fas level is an independent predictor of the need for red blood cell transfusion in critically ill patients with or without acute kidney injury. Further studies are warranted to reconfirm this finding.
Highlights
Ill patients are at high risk for anemia and have high mortality rates[1,2]
Acute kidney injury (AKI), inflammation and erythropoietin (Epo) hyporesponsiveness contribute to the progression of anemia in critical illness[5,6]
Variables were compared between AKI patients and the three remaining groups to investigate the impact of renal impairment on serum levels of Soluble Fas (s-Fas), Epo and inflammatory cytokines
Summary
Ill patients are at high risk for anemia and have high mortality rates[1,2]. Red blood cell transfusion is often required to treat anemia in these patients[1,2,3]. Anemia develops early in the course of critical illness[2,3] and has several consequences in critically ill patients. Red blood cell transfusions improve oxygen delivery in critically ill patients, but not oxygen consumption[4,5]. The anemia of critical illness is a distinct clinical entity with characteristics similar to that of chronic disease anemia[4,5,6]. Acute kidney injury (AKI), inflammation and erythropoietin (Epo) hyporesponsiveness contribute to the progression of anemia in critical illness[5,6]
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