Proenkephalin predicts organ failures, renal replacement therapy, and mortality in sepsis

Abstract

IntroductionKidney failure frequently occurs in sepsis and is associated with high mortality. Proenkephalin (PENK) is an emerging biomarker for sepsis. We evaluated whether the PENK level could predict severity, organ failure, and 30‐day mortality in septic patients.MethodsThe PENK levels were measured using the sphingotest penKid assay (Sphingotec GmbH, Hennigsdorf, Germany) in a total of 215 septic patients. The PENK levels were analyzed in terms of sepsis severity, vasopressor use, 30‐day mortality, sequential (sepsis‐related) organ failure assessment (SOFA) renal subscore, the Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (CKD‐EPI eGFR) categories, and requiring renal replacement therapy (RRT). The number of organ failures, SOFA subscores, requiring RRT, and 30‐day mortality were compared according to the PENK quartiles.ResultsThe PENK levels were significantly higher in patients with septic shock, vasopressor use, and non‐survivors than in patients with solitary sepsis, no vasopressor use, and survivors, respectively (all P < 0.01). The PENK levels were significantly associated with SOFA renal subscore and CKD‐EPI eGFR categories (all P < 0.0001). The PENK quartiles were associated with the number of organ failures as well as SOFA renal, cardiovascular, respiratory, and central nervous system subscores (all P < 0.05). The PENK levels were significantly higher in patients who required RRT than in those who did not require RRT (P < 0.0001). High PENK level was also associated with high 30‐day mortality (P < 0.0001).ConclusionsPENK could be a useful and objective marker to predict severity, organ failure, and 30‐day mortality in septic patients.