Abstract
BackgroundSepsis is the most common cause of acute kidney injury (AKI) among critically ill patients. This study aimed to determine whether presepsin is a predictor of septic acute kidney injury, renal replacement therapy initiation (RRTi) in sepsis patients, and prognosis in septic AKI patients.MethodsPresepsin values were measured immediately after ICU admission (baseline) and on Days 2, 3, and 5 after ICU admission. Glasgow Prognostic Score (GPS), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, Prognostic Index, and Prognostic Nutritional Index (PNI) were measured at baseline, and total scores (“inflammation-presepsin scores [iPS]”) were calculated for category classification. Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with and without septic AKI or RRTi and between survivors and non-survivors.ResultsReceiver operating characteristic curve analyses identified the following variables as predictors of septic AKI and RRTi in sepsis patients: presepsin on Day 1 (AUC: 0.73) and Day 2 (AUC: 0.71) for septic AKI, and presepsin on Day 1 (AUC: 0.71), Day 2 (AUC: 0.9), and Day 5 (AUC: 0.96), Δpresepsin (Day 2 – Day 1) (AUC: 0.84), Δpresepsin (Day 5 – Day 1) (AUC: 0.93), and PNI (AUC: 0.72) for RRTi. Multivariate logistic regression analyses identified presepsin on Day 2 as a predictor of prognosis in septic AKI patients.ConclusionsPresepsin and PNI were found to be predictors of septic AKI, RRTi in sepsis patients, and prognosis in septic AKI patients.
Highlights
Sepsis is the most common cause of acute kidney injury (AKI) among critically ill patients
The present study aimed to prove the following hypotheses: 1) presepsin can predict septic AKI, replacement therapy initiation (RRTi) in sepsis intensive care unit (ICU) patients, and prognosis in septic AKI ICU patients; and 2) the ability of presepsin to predict the above are superior to inflammation-based prognostic scores and can be improved by combining presepsin values with inflammation-based prognostic scores
There were 38 septic AKI patients defined as stage ≥1 according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, and 6 underwent RRTi after ICU admission
Summary
Sepsis is the most common cause of acute kidney injury (AKI) among critically ill patients [3]. Presepsin has a higher specificity for sepsis diagnosis compared with PCT and IL-6 [12], and could be useful for the prognosis of sepsis and monitoring the course of the disease [13]. Another advantage of presepsin is that it can be measured in less than 17 min with a compact fully automated immunoanalyzer (PATHFAST®; Mitsubishi Chemical Medience Corporation, Tokyo, Japan) [14]
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