Creatinine Values Research Articles

Review of the limitations of current biomarkers in acute kidney injury clinical practices.

Acute kidney injury is a prevalent disease in hospitalized patients and is continuously increasing worldwide. Various efforts have been made to define and classify acute kidney injury to understand the progression of this disease. Furthermore, deviations from structure and kidney function and the current diagnostic guidelines are not adequately placed due to baseline serum creatinine values, which are rarely known and estimated based on glomerular function rate, resulting in misclassification of acute kidney injury staging. Hence, the current guidelines are still developing to improve and understand the clinical implications of risk factors and earlier predictive biomarkers of acute kidney injury. Yet, studies have indicated disadvantages and limitations with the current acute kidney injury biomarkers, including lack of sensitivity and specificity. Therefore, the present narrative review brings together the most current evidenced-based practice and literature associated with the limitations of the gold standard for acute kidney injury diagnoses, the need for novel acute kidney injury biomarkers, and the process for biomarkers to be qualified for diagnostic use under the following sections and themes. The introduction section situates the anatomy and normal and abnormal kidney functions related to acute kidney injury disorders. Guidelines in providing acute kidney injury definitions and classification are then considered, followed by a discussion of the disadvantages of standard markers used to diagnose acute kidney injury. Characteristics of an ideal acute kidney injury biomarker are discussed concerning sensitivity, specificity, and anatomic location of injury. A particular focus on the role and function of emerging biomarkers is discussed in relation to their applications and significance to the prognosis and severity of acute kidney injury. Findings show emerging markers are early indicators of acute kidney injury prediction in different clinical settings. Finally, the process required for a biomarker to be applied for diagnostic use is explained.

The influence of optimal blood pressure control on the progression of chronic kidney disease

Background/Aim: Chronic kidney disease (CKD) has seen a rapid increase worldwide in recent decades, now recognised as a global health issue of the 21st century. Optimal, continuous control of hypertension represents a crucial part of treatment capable of slowing the progression of CKD. The aim of this study was to demonstrate that optimal regulation blood pressure control in patients with essential and secondary hypertension, along with CKD, slows the progression of CKD. Methods: The research was conducted at the University Clinical Centre of the Republic of Srpska, Banja Luka, Internal Clinic Nephrology Department. A retrospective-prospective study was blind for patients and lasted for 24 months. It included 97 patients, aged 18 and above, of both genders, hypertensive, in the 3rd or 4th stage of CKD (creatinine clearance of 15-59 mL/min). Assess the outcome of CKD, a "complex (undesirable) clinical outcome" was taken - one of three fundamental clinically undesirable events: double increase in serum creatinine values at the end of 24 months, onset of terminal renal insufficiency, or patient death. Patients were classified into three groups: I group - 30 patients with essential hypertension and CKD with optimally regulated blood pressure; II group - 32 patients with secondary hypertension and CKD with optimally regulated blood pressure; III control group - 35 patients with hypertension of various causes and CKD who did not achieve target blood pressure values. Blood pressure control was measured from month 0 to month 24 - once a month. Laboratory tests were taken every 3 months (red blood cells, haemoglobin, glycaemia, cholesterol, urea, creatinine, uric acid, sodium, potassium in serum and urine). Results: There was a highly statistically significant difference in glomerular filtration rate in the first group compared to the third group and in the second group compared to the third group. No statistically significant difference in glomerular filtration rate between the first and second groups was observed, where good blood pressure regulation was achieved. Conclusion: Optimal blood pressure control in the examined groups, regardless of the cause of CKD, was responsible for slowing the progression of CKD compared to the group with unregulated blood pressure.

Dynamic indicators of acute respiratory diseases treatment in children after correction.

Aim: To study the Respiratory pathology of the upper respiratory tract, markers of the inflammatory response of the organism, Oxidative stress, Metabolic adaptation and possibilities of correction. Materials and Methods: The study group (n=111) included school-aged children (10-14 years old). The general group of inflammatory diseases of the respiratory tract (J000-J06) was considered, with a diagnosis of acute respiratory infection (ARI) of viral and bacterial origin and included local inflammationof the upper respiratory tract with presentation of acute pharyngitis (68.0%), acute bronchitis (22,0%), acute tonsillitis (10,0%). Results: Dynamic observation of groups of children who received optimized (group 1, n=60) and basic (group 2, n=51) treatment was carried out. The level of the erythrocyte pool correlated with IL-1 (r=-0,29, p=0,03), IL-4 (r=0,32, p=0,01), TNF-α (r=-0,35 , p=0,006). Creatinine value correlated with IL-10 (r=0,3, p=0,005), γ-IFN (r=0,42, p=0,001), TNF-α (r=0,25, p=0,05). Correlations of ferritin presented positive correlation values with the level of total protein (r=0,26, p=0,04) and TNF-α (r=0,41, p=0,001). Conclusions: After the optimized treatment, there was a significant decrease in the reliable levels of CRP and γ-IFN by 7 and 4,4 times (by groups) and 5,8 and 3,2 times (by groups), respectively. Correlation relationships of urea levels with IL-2,4 were detected. The level of the erythrocyte pool correlated with IL-1,4, TNF-α, Ferritin presented positive correlation values with the level of total protein,TNF-α .

Optical coherence tomography-angiography findings of prediabetic patients.

The purpose of this study was to evaluate prediabetic patients for microvascular changes using optical coherence tomography-angiography (OCT-A) and compare with diabetic patients and healthy controls. OCT-A images of 60 eyes of 30 patients with diabetes mellitus (DM), 72 eyes of 36 prediabetic patients, and 108 eyes of 54 healthy controls were retrospectively evaluated and compared in this study. A swept-source OCTA (Triton, Topcon) instrument was used for collecting OCT-A images. Duration of the diabetic or prediabetic period, glycated hemoglobin, fasting blood glucose level, postprandial glucose (PPG) level, high-density lipoprotein, low-density lipoprotein, triglyceride, and creatinine values of all participants were recorded. Microaneurysm, nonperfusion areas, perifoveal capillary disruption, and capillary network disorganization were detected in both prediabetics and diabetics but statistically more common in diabetic patients. Neovascularization and intraretinal microvascular anomalies were detected only in diabetic patients. OCT-A seemed to be effective in detecting microvascular changes in diabetic patients. More importantly, results showed us that in prediabetic patients, microvascular changes can be seen before the onset of DM and before or concurrently with neurodegenerative changes.

Hypokalemic Paralysis Due to Distal Renal Tubular Acidosis, Case Report

Distal renal tubular acidosis (dRTA) is a metabolic disease characterized by hypokalemia, hyperchloremic metabolic acidosis and urine pH above 5.5. These findings may be accompanied by hypercalciuria, nephrocalcinosis, nephrolithiasis, jaundice, osteomalacia or rickets in children. Although hypokalemia is frequently seen as a laboratory finding in dRTA, weakness, which is the clinical finding of this deficiency, is rare. A 33-year-old female patient was brought to the emergency department (ED) with complaints of weakness, loss of strength in the extremities, and difficulty in breathing. Laboratory analyzes of the patient revealed metabolic acidosis and hypokalemia. Urea and creatinine values were normal. The patient was admitted to the internal medicine department with a preliminary diagnosis of dRTA and hypokalemic paralysis. Initially, parenteral infusion of KCl and NaHCO3 was administered in the treatment. In the follow-up of the patient, it was observed that hypokalemia and metabolic acidosis improved from the 3rd day and clinical findings improved within 36 hours following the replacement therapy. dRTA, which is rare in adults, is among the secondary causes of hypokalemic paralysis. dRTA should be considered among the differential diagnoses in the presence of hypokalemia and metabolic acidosis in patients presenting with bilateral weakness.

Rotavirus Gastroenteriti Olan Hastalarda Elektrolit Dengesizliği ve Kan Gazı Parametrelerinin Değerlendirilmesi

Aim: In the present study, the cases admitted to the hospital because of acute gastroenteritis and diagnosed with common RVGE were evaluated in terms of demographic, epidemiological, clinical, and laboratory data. Methods: The clinical and laboratory data of the cases who applied to Selçuk University Faculty of Medicine, Pediatric Emergency Clinic because of acute gastroenteritis aged 0-18 were evaluated retrospectively in the study. Clinical findings, time of admission, place of observation, blood gas and electrolyte levels, electrolyte imbalance, and length of hospital stays of the patients were recorded. Results: Among the AGE patients who were included in the study, 148 (61.2%) were male and 94 (38.8%) were female. The incidence of hypokalemia in patients who had RV(+) GE was statistically significant. Statistically significant differences were detected between the groups in terms of creatinine, potassium, AST, ALT and albumin values of biochemical parameters. When the blood gas analysis of patients who had AGE was evaluated, although acidosis was detected in 24 (9.9%) patients who had pH value, alkalosis was detected in 27 (11.2%) patients. Conclusion: Cases with metabolic acidosis in rotavirus gastroenteritis are hospitalized more frequently, and for this reason, blood gas studies in cases of RV gastroenteritis will guide clinicians.

The correlation between serum creatinine and burn severity and its predictive value.

This study aimed to explore the correlation between serum creatinine and burn severity and the value of predicting the outcome of patients. For this purpose, a total of 268 burn patients (BUP) were collected. According to the burn area, they were divided into mild group (MIG) (n = 125, burn area 30% - 49%), moderate group (MOG) (n = 80, burn area 50% - 79%) and severe group (SEG) (n = 63, burn area ≥ 80%). According to the prognosis, they were divided into survival group (SUG) (n = 170) and death group (DEG) (n = 98). At the same time, the control group (COG) was selected from the physical examination center of our hospital. 5 mL of fasting venous blood was collected from all BUP on the first, seventh, 14th and 21st days after admission. 5 mL of fasting venous blood was collected from the COG. Creatinine (CRE) level was measured by enzyme method. Cholinesterase (CHE) level in serum was measured by improved Ellman method. The changes of CRE and CHE in serum were compared among all groups to explore the correlation between serum creatinine and burn severity and its prediction Measure the value of patients' outcomes. Results showed that except for the first day after burn, the level of serum CRE in BUP was raised than that in the COG, and the level of serum CHE in BUP was reduced than that in the COG (P<0.05). The serum CHE level of BUP in all groups increased at first and then decreased, and the highest level was on the first day after injury. At the same time, the level of CRE in SEG was raised than that in MIG and MOG, and the level of CRE in MOG was raised than that in MIG (P<0.05). The serum CHE level of BUP in all groups decreased at first and then increased, and the lowest level was on the first day after injury. At the same time, the level of CRE in SEG was reduced to that in MIG and MOG, and the level of CRE in MOG was reduced to that in MIG (P<0.05). The level of CRE in serum of BUP in both groups increased at first and then decreased, and the level was the highest on the first day after injury. At the same time, the level of CRE in the DEG was raised than that in the SUG (P<0.05). The level of CHE in serum of BUP in both groups decreased at first and then increased, and the level was the lowest on the first day after injury. At the same time, the level of CRE in the death group was reduced than that in the SUG (P<0.05). Logistic regression analysis showed that there was statistical significance in the regression coefficients on the 1st, 7th, 14th and 21st day after burn, and on the 1st and 21st day after-burn. ROC curve analysis shows that CRE and CHE have certain value in diagnosing the prognosis of BUP, and the diagnostic value of CRE is higher. Cre level increases with the aggravation of burn patients, and ChE level decreases with the aggravation of BUP. In conclusion, Cre and ChE have certain value in diagnosing the prognosis of BUP and can be widely used in clinical practice.

Comparison of Metabolic Effects of Three Different Treatment Combinations with Retrospective Real-life Data in People Living with HIV.

Comorbidities are increasing in people living with HIV (PLHIV), and different treatment options have advantages and disadvantages. It is important to compare information from real-life treated cases. The aim of this study was to retrospectively evaluate the data on efficacy and clinical and laboratory findings during different antiretroviral therapies. Retrospective file data of 47 PLHIV using Dolutegravir and Lamivudine (3TC/DTG), Tenofovir Alafenamide Emtricitabine and Elvitegravir Cobicistat (EVG/c/TAF/FTC) and Tenofovir Disoproxil Fumarate and Emtricitabine and Efavirenz (EFV/FTC/TDF) were analyzed. Data of the patients at baseline and 12 months after antiretroviral therapy (ART) were compared. About 47 PLHIV were included in the study. Of the patients, 22 (46.8%) were in the 3TC/DTG group, 19 (40.4%) in the EVG/c/TAF/FTC, and 6 (12.8%) in the EFV/FTC/TDF group. After 12 months of treatment, BMI, HIV-RNA, CD4, WBC, hemoglobin, MCV, PDW, RDW, platelet count, creatinine, eGFR, HDL, AST, glucose values of the 3TC/DTG group were significantly different (p<0.05). After 12 months of treatment, BMI, HIV-RNA, CD4 count, MCV, creatinine, eGFR, HDL, LDL, TG, TC, AST, and HOMA-IR values of the EVG/c/TAF/FTC treatment group were significantly different (p<0.05). After 12 months of treatment, HIV RNA, total bilirubin, and LDL values in the EFV/FTC/TDF treatment group were statistically different (p<0.05). All treatment groups showed a decrease in HIV-RNA and an increase in CD4 at the end of one year. While CD4 elevation is lower in EFV recipients than in integrase inhibitor (INSTI) recipients, weight gain is higher in INSTI recipients. While the lipid profile was more positively affected in the 3TC/DTG group, lipid profiles were more negatively affected in the EVG/c/TAF/FTC group, although liver and kidney functions were preserved.

Effect of Tempuyung (Sonchus arvensis L.) Leaf Extract on Kidney Histology of Mice Exposed to Plasmodium berghei

Plasmodium berghei is a parasite that causes complications or damage to the kidneys with elevated values of blood urea nitrogen (BUN) and creatinine in the blood. Tempuyung (Sonchus arvensis L.) leaf extract contains antioxidant compounds in the form of flavonoids which has the potential to reverse kidney damage. This study aimed to determine the effect of various doses of tempuyung leaf extract on kidney histology in mice exposed to Plasmodium berghei. This study used a completely randomized design method with 28 male BALB/c mice aged 6-8 weeks. They were divided into 7 treatment groups, namely KN (Normal Control), K+ (received 10mg/kg BW (bodyweight) of chloroquine diphosphate solution), K- (infected with P. berghei only), P1 (received 1 mg/kg BW of S. arvensis), P2 (10mg/kg BW of S. arvensis), P3 (received S. arvensis 100mg/kg BW), P4 (received S. arvensis 200mg/kg BW). Except in KN treatment group, all other treatment groups were infected with P. berghei .prior to oral administration of S. arvensis. The S. arvensis treatment was carried out for 7 days after which the blood serum was taken intracardially, and the kidneys were removed for histological studies. The results showed that tempuyung leaf extract had a significant effect on the repair of glomerular cells that experienced hydropic degeneration and necrosis but has no significant effect on glomerular atrophy. Thus, tempuyung leaves have the potential to reverse kidney complications caused by malaria.

Correlation between Kidney Uptake at [18F]FDG PET/CT and Renal Function.

Different insights into the connection between kidney [18F]fluorodesoxyglucose ([18F]FDG) uptake at positron emission tomography/computed tomography (PET/CT) and renal function have been proposed in the past. The aim of this study was therefore to assess the presence of a correlation between these two parameters. Kidney uptakes were assessed and compared to the creatinine (Cr) values and estimated glomerular filtration rate (EGFR) among different classes of renal functional impairment or kidney status. A total of 339 patients and 385 different PET/CT scans were included in this study. Significant correlations between kidney uptakes and renal function parameters were reported in most of the groups studied, with the exception of patients with Cr < 1.2 mg/dL and subjects with a kidney transplantation. Strong concordance in the assessment of renal parenchymal uptakes between the different readers was reported. To conclude, strong correlations for renal [18F]FDG uptake with Cr levels and the EGFR were reported, with the exception of the group of patients with a Cr value < 1.2 mg/dL and for the group with a kidney transplantation.

Association of Gender, Age, Physiological, and Biochemical Parameters among Chronic Renal Failure Patients at Zawia Kidney Hospital

Background and objectives. Chronic renal failure is a major problem and one of the main causes of morbidity and mortality in the world. kidneys maintain internal balance of water, salts and minerals by eliminating waste products from the body. This study conducted to evaluate the association of physiological and biochemical changes among patients with renal failure who undergo dialysis compared to healthy people. Also, to identify the incidence of CKD in males and females. Methods. This study was conducted from January 2020 to December 2020 at Zawia Kidney Hospital. It was including 114 patients with chronic renal failure and 75 healthy people. The biochemical variables which were examined in the blood serum include glucose, triglycerides and cholesterol, urea, creatinine, and electrolytes in patients with renal failure as well as the healthy people. Results. This study showed that patients aged over 31year had higher frequency of kidney failure. There was a statistically significant difference in the glucose levels between the patient’s group and the control group (p &lt; 0.001) with patients having higher average glucose levels compared to the control group. There were no statistically significant differences between the two groups in cholesterol levels (p˂0.904). However, there was a statistically significant difference in triglyceride levels between patients and controls (p-value =0.021) as patients having higher levels compared to the control group. Statistically significant differences observed in urea, creatinine, calcium, sodium, potassium and phosphate values among renal failure and control groups as (p˂0.001 for each). In the relationship between blood type patients and kidney disease, the results showed a significant association between blood type and kidney failure (p&lt;0.001). Also, our study revealed that there is a significant correlation between gender and chronic renal failure (p&lt;0.001). In addition, an odds ratio of 11.7 indicates that the odds of men developing kidney failure are 11.7 times higher than that of women. Conclusion. Older ages, male, and O blood group are risk factors for chronic renal failure. Clear difference in the level of biochemical parameters in chronic renal failure compared to healthy people.

Fabrication and Characterization of Chitosan-Polyvinyl Pyrolidone K-30 for Creatinine Transport Membranes

The investigation of membrane-based hemodialysis is an interesting study due to its efficacy in eliminating metabolic waste compounds, such as creatinine, from the body. However, not all membrane types exhibit optimal transport capabilities, necessitating modifications. In this study, we conducted modifications on chitosan (CS) membranes by incorporating polyvinyl pyrrolidone K-30 (PVP K-30) and assessing their physicochemical characteristics. The modified membrane underwent characterization and subsequent evaluation of its transport capabilities. The primary objective of this research is to design a membrane composed of chitosan and PVP K-30 with enhanced creatinine transport capabilities. The study commenced with the fabrication of CS membranes combined with CS-PVP, involving six variations of CS and PVP K-30 with volume ratios of 5:0, 4:1, 3:2, 1:1, 2:3, and 4:1. The resulting solution was then printed into a flat sheet membrane. All completed membranes underwent comprehensive characterization, including tests for functional groups using Fourier Transform Infrared (FTIR), membrane weight and thickness, porosity, water absorption, swelling, hydrophilicity, pH resistance, and biodegradation. In the final phase, the membrane was utilized in the creatinine transport process. FTIR analysis of the CS-PVP K-30 membrane revealed O-H and N-H group spectra at wave numbers 3363.06 cm-1 and 1587.17 cm-1, indicating hydrogen bonding between the two polymers. Characterization tests demonstrated that the CS-PVP membrane exhibited increased porosity, water absorption, swelling, and hydrophilicity. In the creatinine transport test, the CS-PVP membrane demonstrated enhanced creatinine transport ability compared to the CS membrane. The highest clearance value for creatinine was observed in the CS-PVP5 membrane, with an increase in the amount of PVP K-30 correlating with an elevated creatinine clearance value. The creatinine clearance values for the CS membrane, CS-PVP1, CS-PVP2, CS-PVP3, CS-PVP4, and CS-PVP5 were 0.30, 0.36, 0.37, 0.39, 0.42, and 0.46 mg/dL, respectively.

Performance of the European Kidney Function Consortium (EKFC) creatinine-based equation in United States cohorts

Estimating glomerular filtration rate (GFR) is important in daily practice to assess kidney function and adapting the best clinical care of patients with and without chronic kidney disease. The new creatinine-based European Kidney Function Consortium (EKFC) equation is used to estimate GFR. This equation was developed and validated mainly in European individuals and based on a rescaled creatinine, with the rescaling factor (Q-value) defined as the median normal value of serum creatinine in a given population. The validation was limited in Non-Black Americans and absent in Black Americans. Here, our cross-sectional analysis included 12,854 participants from nine studies encompassing large numbers of both non-Black and Black Americans with measured GFR by clearance of an exogenous marker (reference method), serum creatinine, age, sex, and self-reported race available. Two strategies were considered with population specific Q-values in Black and non-Black men and women (EKFCPS) or a race-free Q-value (EKFCRF). In the whole population, only the EKFCPS equation showed no statistical median bias (0.14, 95% confidence interval [-0.07; 0.35] mL/min/1.73m2), and the bias of the EKFCRF (0.74, [0.51; 0.94] mL/min/1.73m2) was closer to zero than that of the CKD-EPI2021 equation (1.22, [0.99; 1.47]) mL/min/1.73m2]. The percentage of estimated GFR within 30% of measured GFR was similar for CKD-EPI2021 (79.2% [78.5%; 79.9%]) and EKFCRF (80.1% [79.4%; 80.7%]), but improved with the EKFCPS equation (81.1% [80.5%; 81.8%]). Thus, our EKFC-equations can be used to estimate GFR in the United States incorporating either self-reported race or unknown race at the patient’s discretion per hospital registration records.

Hematological and biochemical effect of subcutaneous administration of robenacoxib in different goat breeds

Aim:This study aimedto investigate the effect of robenacoxibonhematological and biochemical parameters in healthy Alpine and Saanen goats 24 hours after subcutaneous administration. Materials and Methods: 12 healthy Alpine (n=6) and Saanen (n=6) breed goats were used. Robenacoxib was administered to Alpine and Saanen goats at a dose of 4 mg/kg once subcutaneously. Blood samples were collected before drug administration (0 hour) and then 24-hours. Hematological and biochemical parameters were analyzed using a hematology analyzer and biochemistry auto analyzer, respectively. Results: No change was observed in the clinical examination findings of both goat breeds. Statistical differences in hematological and biochemical parameters were determined within physiological limits in both goat breeds. The white blood cell, red blood cell and lymphocyte values were found to be low, and the monocyte% value was found to be high in Alpine goats. Decreases in red blood cell, hemoglobin and hematocrit levels and increases in the mean corpuscular volume and mean corpuscular hemoglobin values were observed at 24-hours in Saanen goats. Robenacoxib increases blood urea nitrogen value in both goat breeds, it decreases creatinine value in Saanen goats. Conclusion: There were no significant changes in hematological and biochemical parameters after robenacoxib administrations to Alpine and Saanen goats. Consequently, further studies are needed to investigate the effects of robenacoxib in high-dose and repeated administrations, liver and kidney dysfunctions, different age, breed, and physiological conditions. It was evaluated that robenacoxib could be used as an alternative NSAID to prevent pain and inflammation in goats, since no adverse effect was observed in the blood profile.

Use of non-steroidal anti-inflammatory drugs in renal transplant patients: A retrospective study.

Renal transplanted patients are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for analgesic purposes. Considering the dearth of data, we carried out the present study to evaluate the use of various NSAIDs and the incidence of acute kidney injury (AKI) in transplant patients. A retrospective study amongst renal transplant patients prescribed at least one dose of NSAID was carried between January and December 2020 at the Department of Nephrology, Salmaniya Medical Complex, Kingdom of Bahrain. The patients' demographic details, serum creatinine values, and drug-related details were obtained. The Kidney Disease Improving Global Outcomes (KDIGO) criteria were used for defining AKI. Eighty-seven patients were included. Forty-three patients were prescribed diclofenac, 60 received ibuprofen, six received indomethacin, 10 were administered mefenamic acid, and 11 received naproxen. Due to multiple courses of NSAID prescription, a total of 70 prescriptions were identified for diclofenac, 80 for ibuprofen, six for indomethacin, 11 for mefenamic acid, and 16 for naproxen. No significant differences were observed in the absolute (p =0.08) and percent changes in serum creatinine (p =0.1) between the NSAIDs. Twenty-eight (15.2%) courses of NSAID therapy met the KDIGO criteria for AKI. Age (OR: 1.1, 95% CI: 1.007, 1.2; p =0.02), concomitant everolimus (OR: 483, 95% CI: 4.3, 54407; p =0.01), and mycophenolate + cyclosporine + azathioprine (OR: 63.4E+006, 95% CI: 203.2157 to 19.8E+012; p =0.005) administration were observed with significant risk of NSAID-induced AKI. We observed possible NSAID-induced AKI to an extent of around 15.2% in our renal transplant patients. No significant differences were observed in the incidence of AKI between various NSAIDs and none of them had either graft failure or death.

Variation in presepsin and thrombomodulin levels for predicting COVID-19 mortality

Coronavirus disease (COVID-19) has caused extensive mortality globally; therefore, biomarkers predicting the severity and prognosis of COVID-19 are essential. This study aimed to evaluate the application of presepsin (P-SEP) and thrombomodulin (TM), which are biomarkers of sepsis and endothelial dysfunction, respectively, in the prognosis of COVID-19. Serum P-SEP and TM levels from COVID-19 patients (n = 183) were measured. Disease severity was classified as mild, moderate I, moderate II, or severe based on hemoglobin oxygen saturation and the history of intensive care unit transfer or use of ventilation at admission. Patients in the severe group were further divided into survivors and non-survivors. P-SEP and TM levels were significantly higher in the severe group than those in the mild group, even after adjusting for creatinine values. In addition, TM levels were significantly higher in non-survivors than in survivors. Changes in the P-SEP levels at two time points with an interval of 4.1 ± 2.2 days were significantly different between the survivors and non-survivors. In conclusion, TM and continuous P-SEP measurements may be useful for predicting mortality in patients with COVID-19. Moreover, our data indicate that P-SEP and TM values after creatinine adjustment could be independent predictive markers, apart from renal function.

Predictive role of glycocalyx components and MMP-9 in cardiopulmonary bypass patients for ICU stay

BackgroundShedding of glycocalyx is relevant to worse prognosis in surgical patients, and elevated levels of serum matrix metalloproteinase-9 (MMP-9) are associated with this phenomenon. This study aimed to investigate the dynamic alterations of serum glycocalyx components and MMP-9 during cardiopulmonary bypass (CPB), and evaluate their predictive capacities for prolonged intensive care unit (ICU) stay, as well as their correlation with coagulation dysfunction. MethodsThis retrospective study analyzed serum levels of syndecan-1, heparan sulfate (HS), and MMP-9 at different time points during CPB, and assessed their association with prolonged ICU stay and coagulation dysfunction. ResultsSyndecan-1, HS, and MMP-9 exhibited divergent changes during CPB. Serum levels of syndecan-1 (AUC = 78.0 %) and MMP-9 (AUC = 78.4 %) were validated as reliable predictors for prolonged ICU stay, surpassing the predictive value of creatinine (AUC = 70.0 %). Syndecan-1 (rho = 0.566, P < 0.01 at T1 and rho = 0.526, P < 0.01 at T2) and HS (rho = 0.403, P < 0.05 at T4) exhibited correlations with activated partial thromboplastin time (APTT) ratio beyond the normal range. ConclusionsOur findings advocate the potential efficacy of serum glycocalyx components and MMP-9 as early predictive indicators for extended ICU stay following cardiac surgery with CPB. Additionally, we observed a correlation between glycocalyx disruption during CPB and coagulation dysfunction. Further studies with expansive cohorts are warranted to consolidate our findings and explore the predictive potential of other glycocalyx components.

When hemorrhagic enterititis can cause anemia and thrombocytopenia without significant kidney damage.

A healthy 9-years-old boy was brought to the Emergency Department for widespread abdominal pain associated with bloody diarrhoea and significant tenesmus, in the absence of fever. Blood tests were compatible with an acute gastroenteritis, even though microbiological tests on stools resulted negative. Given the haemorrhagic dysentery, the boy was hospitalized to start empiric antibiotic therapy and intravenous rehydration. Abdominal ultrasound showed a thickening of colonic walls, mimicking an inflammatory intestinal disease at the onset (subsequently denied by gastro-colonoscopy). Seven days after the onset of symptoms, blood tests revealed microangiopathic anaemia with negative Coombs test, associated with thrombocytopenia. Urine dipstick revealed haematuria and proteinuria in nephritic range. No contraction of diuresis or alteration of renal function were observed (being creatinine values always within the normal range). Laboratory tests were consistent with the diagnosis of Haemolytic Uremic Syndrome (Hus) at the onset. Approximately 1% of paediatric patients with bloody diarrhoea can develop Hus. Positivity for Escherichia coli is not always evident in the stools. Thus, the triad of haemolytic anaemia, thrombocytopenia and renal failure could be present in only 60% of Hus at the onset. The finding of haematuria and/or proteinuria on the urine dipstick may be indicative of early kidney damage, allowing for careful monitoring and a rehydration program that can prevent progression of kidney damage and extrarenal complications.

Impact of acute kidney injury on major adverse cardiovascular events in intensive care survivors

BackgroundAcute kidney injury commonly occurs in patients admitted to ICU. After acute kidney injury, kidney function may not completely recover leading to increased risk of future cardiovascular events. We sought to ascertain the rates of cardiovascular events in ICU survivors and if these rates were affected by the presence of acute kidney injury whilst in ICU. MethodsThis retrospective observational cohort study utilised routinely collected data to identify patients who had survived an admission to one of two ICUs between July 2015 and June 2018. Baseline serum creatinine and subsequent values were used to identify acute kidney injury. Major adverse cardiovascular events described were myocardial injury, coronary artery intervention, or radiological evidence of stroke. ResultsOf the 3994 ICU survivors, major adverse cardiovascular events were identified in 385 patients (9.6%; 95% confidence interval [CI] 8.8–10.6%). Presence of acute kidney injury whilst in ICU was significantly associated with future major adverse cardiovascular events (hazard ratio=1.38; 95% CI 1.12–1.70; P-value=0.003) and future biochemical myocardial injury (hazard ratio=1.48; 95% CI 1.16–1.89; P-value=0.001). Acute kidney injury did not have a statistically significant association with future coronary artery interventions or future cerebrovascular events. ConclusionsOne in 10 ICU survivors experiences a major adverse cardiovascular event after discharge. Acute kidney injury whilst in ICU was associated with an increased risk of major adverse cardiovascular events and specifically myocardial injury. Further research is warranted on whether ICU survivors with acute kidney injury merit enhanced strategies for cardiovascular protection.

Dietary supplementation with a mixture of Dunaliella salina and Spirulina enhances broiler performance by improving growth, immunity, digestive enzymes and gut microbiota

The aim of this study is to evaluate the effect of Dunaliella salina and Spirulina (D + S) mixture on performance, carcass yield, kidney and liver markers, lipid profile, and immune responses of fattening chicks. Two hundred broiler chicks at 7 days old were distributed into 5 experimental groups, 5 replicates each with 8 chicks each. Group 1 was fed on only basal diet; group 2 was fed with basal diet and 0.50 g/kg (D + S); group 3 was fed with basal diet and 1.00 g/kg (D + S); group 4 was fed with basal diet and 1.50 g/kg (D + S); and group 5 was fed with basal diet supplemented with 2.00 g/kg (D + S). The additive mixture (D + S) consisted of (1 D. salina: 1 Spirulina). The experiment lasted for 6 wk. The results demonstrated significantly improved better live body weight, body weight gain, and feed conversion ratio (P<0.01) for groups that received (D + S) at levels of 1.0 and 1.5 g/kg diet compared to other groups at 6 wk of age. There was no significant influence of different levels of dietary feed additives on feed intake or carcass traits. The lipid profile was improved through a reduction of total cholesterol and low-density lipoprotein (LDL) values and increasing high-density lipoprotein (HDL) values, as well as the immune response, which was improved through increasing values of complement 3, immunoglobulin M (IgM), and immunoglobulin G (IgG) in the birds treated with (D + S) compared to the control group. The inclusion of all levels of (D + S)/kg decreased triglyceride, while total protein, albumen, and globulin values (P<0.05 or P<0.01) were higher compared to other groups. The inclusion of the different levels of (D + S)/kg improved liver function, whereas aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were lower than in other groups (P<0.001). The lowest values of creatinine, urea, and uric acid were noted in birds fed a diet supplemented with 1.50 g (D + S)/kg. Antioxidant levels were improved through increasing values of catalase (CAT) and reduced glutathione (GSH) enzymes in the treated birds with (D + S) compared with the control chicks. Furthermore, digestive enzymes and microbial content were improved in broiler checks fed on diet supplemented with (D + S) compared to the control group. In conclusion, supplementing broiler chicks with a dietary D. salina and Spirulina combination increased their productive performance, immunity, kidney and liver function, lipid profile, and digestive enzymes.