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

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Jäntti, T (Author) Other; Tarvasmäki, T (Author) Other; Harjola, V (Author) Other; Pulkki, K (Author) Other; Turkia, H (Author) Other; Sabell, T (Author) Other; Tolppanen, H (Author) Other; Jurkko, R (Author) Other; Hongisto, M (Author) Other; Kataja, A (Author) Other; Sionis, A (Author) Other; Silva Cardoso, J (Author) FMUP; Banaszewski, M (Author) Other; DiSomma, S (Author) Other; Mebazaa, A (Author) Other; Haapio, M (Author) Other; Lassus, J (Author) Other

Journal

The Journal is awaiting validation by the Administrative Services.

Title: ANNALS OF INTENSIVE CARE

ISSN: 2110-5820

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 6 Citations

Other information

Authenticus ID: P-00V-ZTD

DOI: 10.1186/s13613-021-00814-8

Abstract (EN): Background: Acute 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. Results: P-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. Conclusions: High 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.

Language: English

Type (Professor's evaluation): Dissemination

No. of pages: 15