Prediction of Postoperative Sepsis Based on Changes in Presepsin Levels of Critically Ill Patients with Acute Kidney Injury after Abdominal Surgery.

Chang Hwan Kim,Eun Young Kim

doi:10.3390/diagnostics11122321

Abstract

Presepsin (PSP) is a viable biomarker for the detection of bacterial infection, but it lacks accuracy when acute kidney injury (AKI) develops. Herein, we evaluated the diagnostic and prognostic value of PSP in predicting postoperative sepsis after abdominal surgery respective to the degree of AKI. A total of 311 patients who underwent abdominal surgery and were admitted to a surgical intensive care unit were enrolled and classified into non-AKI, mild-AKI (stage 1, stage 2 and stage 3 without renal replacement therapy (RRT)) and severe-AKI (stage 3 with RRT) group, according to the Kidney Disease Improving Global Outcomes criteria. In each group, PSP and other biomarkers were statistically analyzed between non-sepsis and postoperative sepsis at the admission (T0), 24 h (T1), 48 h (T2) and 72 h (T3) after surgery. In non-AKI and mild-AKI group, PSP levels were significantly higher in postoperative sepsis than non-sepsis group, whereas no difference was detected in the severe-AKI group. Cutoff values of PSP in the mild-AKI group for the prediction of postoperative sepsis were 544 pg/mL (AUC: 0.757, p < 0.001) at T0 and 458.5 pg/mL (AUC: 0.743, p < 0.001) at T1, significantly higher than in non-AKI group. In multivariate analysis, predictors of postoperative sepsis in the mild-AKI group were PSP at T2 (odds ratio (OR): 1.002, p = 0.044) and PSP at T3 (OR: 1.001, p = 0.049). PSP can be useful for predicting newly developed sepsis in patients with transient AKI after abdominal surgery with modified cutoff values.

Highlights

The participants were divided into non-acute kidney injury (AKI) and AKI groups, and the AKI group was subdivided into two groups according to the degree of severity based on Kidney Disease Improving Global Outcomes (KDIGO) criteria: mild-AKI group, which includes stage 1, stage 2 and stage 3 without renal replacement therapy (RRT); and severe-AKI group, which includes stage 3 with RRT, as shown in (Figure 1) [12]
AKI was defined as occurring within 7 days after surgery or by discharge from surgical intensive care unit (SICU) if discharge was within 7 days, and each grade of AKI was defined according to KDIGO criteria based on Kellum et al, as shown in Table 1 [12]
Our results revealed that the PSP level in severe-AKI group was very high (>2000 pg/mL) regardless of period or presence of postoperative sepsis

Summary

Introduction

Sepsis from abdominal infection is a fatal condition which requires early diagnosis and appropriate treatment in order to avoid its high mortality and morbidity [1]. The continued high risk of sepsis even after surgery for an abdominal infection could be partly explained by the patient’s vulnerability due to the physiological nature of postoperative condition. Intraoperative manipulations of intestine or damaged tissue trigger non-infectious systemic inflammatory response syndrome (SIRS) with clinical manifestations similar to those of early stage sepsis [4]. It may interfere with and delay appropriate resuscitation via misdiagnosis or interfere with the detection of postoperative infectious complication [5]

Methods

Results

Discussion

Conclusion