Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock

Annals of Intensive Care

Jose Silva-Cardoso¹  Toni Jäntti²  Johan Lassus²  Tuukka Tarvasmäki²  Heli Tolppanen²  Tuija Sabell²  Raija Jurkko²  Salvatore DiSomma³  Mari Hongisto⁴  Veli-Pekka Harjola⁴  Heidi Turkia⁵  Kari Pulkki⁵  Alexandre Mebazaa⁶  Alessandro Sionis⁷  Marek Banaszewski⁸  Anu Kataja⁹  Mikko Haapio^1,10 

[1] CINTESIS, Department of Cardiology, São João Hospital Center, and Porto Medical School, University of Porto, Porto, Portugal;Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 HUS, Helsinki, Finland;Department of Medical Sciences and Translational Medicine, Sant’Andrea Hospital, University of Rome Sapienza, Rome, Italy;Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland;HUSLAB Diagnostic Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland;INSERM U942, Department of Anesthesia and Critical Care, Hôpital Lariboisière, APHP, University Paris Diderot, Paris, France;Intensive Cardiac Care Unit, Cardiology Department, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute IIB‐SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain;Intensive Cardiac Therapy Clinic, National Institute of Cardiology, Warsaw, Poland;Internal Medicine, Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, University of Helsinki, Helsinki, Finland;Nephrology, Department of Nephrology, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland;

关键词: Cardiogenic shock;    Acute kidney injury;    AKI;    Mortality;    Prognosis;    Proenkephalin;    PENK;    NGAL;   

DOI  :  10.1186/s13613-021-00814-8

来源: Springer

【 摘 要 】

BackgroundAcute kidney injury (AKI) is a frequent form of organ injury in cardiogenic shock. However, data on AKI markers such as plasma proenkephalin (P-PENK) and neutrophil gelatinase-associated lipocalin (P-NGAL) in cardiogenic shock populations are lacking. The objective of this study was to assess the ability of P-PENK and P-NGAL to predict acute kidney injury and mortality in cardiogenic shock.ResultsP-PENK and P-NGAL were measured at different time points between baseline and 48 h in 154 patients from the prospective CardShock study. The outcomes assessed were AKI defined by an increase in creatinine within 48 h and all-cause 90-day mortality. Mean age was 66 years and 26% were women. Baseline levels of P-PENK and P-NGAL (median [interquartile range]) were 99 (71–150) pmol/mL and 138 (84–214) ng/mL. P-PENK > 84.8 pmol/mL and P-NGAL > 104 ng/mL at baseline were identified as optimal cut-offs for AKI prediction and independently associated with AKI (adjusted HRs 2.2 [95% CI 1.1–4.4, p = 0.03] and 2.8 [95% CI 1.2–6.5, p = 0.01], respectively). P-PENK and P-NGAL levels at baseline were also associated with 90-day mortality. For patients with oliguria < 0.5 mL/kg/h for > 6 h before study enrollment, 90-day mortality differed significantly between patients with low and high P-PENK/P-NGAL at baseline (5% vs. 68%, p < 0.001). However, the biomarkers provided best discrimination for mortality when measured at 24 h. Identified cut-offs of P-PENK24h > 105.7 pmol/L and P-NGAL24h > 151 ng/mL had unadjusted hazard ratios of 5.6 (95% CI 3.1–10.7, p < 0.001) and 5.2 (95% CI 2.8–9.8, p < 0.001) for 90-day mortality. The association remained significant despite adjustments with AKI and two risk scores for mortality in cardiogenic shock.ConclusionsHigh levels of P-PENK and P-NGAL at baseline were independently associated with AKI in cardiogenic shock patients. Furthermore, oliguria before study inclusion was associated with worse outcomes only if combined with high baseline levels of P-PENK or P-NGAL. High levels of both P-PENK and P-NGAL at 24 h were found to be strong and independent predictors of 90-day mortality.Trial registration: NCT01374867 at www.clinicaltrials.gov, registered 16 Jun 2011—retrospectively registered

【 授权许可】

CC BY