Protein carbonyl concentration as a biomarker for development and mortality in sepsis-induced acute kidney injury.

Nara Aline Costa,Paula Schmidt Azevedo,Sergio Alberto Rupp De Paiva,Marcos Ferreira Minicucci,Ana Angelica Henrique Fernandes,Daniela Ponce,André Luís Balbi,Leonardo Antonio Mamede Zornoff,Suzana Erico Tanni,Bertha Furlan Polegato,Ana Lúcia Gut,Natália Baraldi Cunha

doi:10.1042/bsr20171238

Nara Aline Costa, Paula Schmidt Azevedo + Show 10 more

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https://doi.org/10.1042/bsr20171238

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Abstract

The objective of the present study was to evaluate protein carbonyl concentration as a predictor of AKI development in patients with septic shock and of renal replacement therapy (RRT) and mortality in patients with SAKI. This was a prospective observational study of 175 consecutive patients over the age of 18 years with septic shock upon Intensive Care Unit (ICU) admission. After exclusion of 46 patients (27 due to AKI at ICU admission), a total of 129 patients were enrolled in the study. Demographic information and blood samples were taken within the first 24 h of the patient’s admission to determine serum protein carbonyl concentrations. Among the patients who developed SAKI, the development of AKI was evaluated, along with mortality and need for RRT. The mean age of the patients was 63.3 ± 15.7 years, 47% were male and 51.2% developed SAKI during ICU stay. In addition, protein carbonyl concentration was shown to be associated with SAKI. Among 66 patients with SAKI, 77% died during the ICU stay. Protein carbonyl concentration was not associated with RRT in patients with SAKI. However, the ROC curve analysis revealed that higher levels of protein carbonyl were associated with mortality in these patients. In logistic regression models, protein carbonyl level was associated with SAKI development (OR: 1.416; 95% CI: 1.247–1.609; P<0.001) and mortality when adjusted by age, gender, and APACHE II score (OR: 1.357; 95% CI: 1.147–1.605; P<0.001). In conclusion, protein carbonyl concentration is predictive of AKI development and mortality in patients with SAKI, with excellent reliability.

Highlights

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection
In a previous study by our group, we showed that erythrocyte superoxide dismutase (SOD) 1 activity was associated with acute kidney injury (AKI) development in patients with septic shock [7]
The patients who developed Sepsis-induced acute kidney injury (SAKI) presented with higher APACHE Acute Physiology and Chronic Health Evaluation (II) and Sequential Organ Failure Assessment (SOFA) scores, C-reactive protein (CRP), urea, and creatinine values, had more chronic kidney disease (CKD) and increased mortality rate

Summary

Introduction

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. According to the Sepsis-3 definition, septic shock is a subset of sepsis with circulatory and metabolic dysfunction associated with a higher risk of mortality [1]. Despite increased understanding of the pathogenesis of sepsis and the creation of “bundles” of care, the septic shock mortality rate remains high, killing as many as one in four patients [2]. In the past few years, several biomarkers have been studied; only a few of them c 2018 The Author(s).

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