Objective: Early recognition of sepsis is important to prevent progression to severe sepsis and septic shock conditions that may lead to Acute Kidney Injury (AKI). In the present study, the combined measurement of plasma biomarkers NGAL, PCT and MR-proADM in the diagnosis and prognosis of sepsis and sepsis associated acute kidney injury (SA-AKI) was evaluated. Methods: Twenty patients with sepsis, 18 with localized infections, 17 with SIRS and 24 healthy donors have been consecutively enrolled: NGAL, PCT and MR-proADM were measured at admission (T=0), at 24 hours (T=1) and in the third or fifth day of antibiotic therapy (T=3-5) in septic patients and as a single determination (T=0) in the remaining subjects. PCT and MR-proADM were measured by a time-resolved amplified emission method (Kryptor; Brahms AG, Hennigsdorf, Germany). NGAL was measured by turbidimetric immunoassay (NGAL Test, Bio Porto Diagnostics, Denmark). The creatinine was determined using an enzymatic IDM traced spectrophotometric method (Siemens, Healthcare Diagnostics Inc., Italy). Data were analyzed using the statistical package MedCalc 13.2.2.0. Results: NGAL values were significantly higher in sepsis than in SIRS and in patients with bacterial localized infections. The discrimination and diagnostic accuracy of NGAL were supported by ROC curve analysis. At the cut-off value of 300 ng/mL, NGAL identified sepsis with high sensitivity and specificity. In sepsis, NGAL was strictly correlated with PCT and MR-proADM. Stratifying subjects of the study population in five different classes on the basis of PCT, NGAL values were correlated with PCT in each class. NGAL, like MR-proADM, was significantly correlated with APACHE II as well as with SOFA scores of disease severity. Conclusions: Data of the study demonstrated the advantage derived from the combined use of the three markers PCT, MRproADM and NGAL in septic patients’ management and the central role of NGAL in SA-AKI diagnosis and prognosis.
Plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Combination with Procalcitonin (PCT) and MR-proadrenomedullin (MR-proADM) in the Diagnosis and Prognosis of Sepsis and Sepsis Associated Acute Kidney Injury
Angeletti S;
2016-01-01
Abstract
Objective: Early recognition of sepsis is important to prevent progression to severe sepsis and septic shock conditions that may lead to Acute Kidney Injury (AKI). In the present study, the combined measurement of plasma biomarkers NGAL, PCT and MR-proADM in the diagnosis and prognosis of sepsis and sepsis associated acute kidney injury (SA-AKI) was evaluated. Methods: Twenty patients with sepsis, 18 with localized infections, 17 with SIRS and 24 healthy donors have been consecutively enrolled: NGAL, PCT and MR-proADM were measured at admission (T=0), at 24 hours (T=1) and in the third or fifth day of antibiotic therapy (T=3-5) in septic patients and as a single determination (T=0) in the remaining subjects. PCT and MR-proADM were measured by a time-resolved amplified emission method (Kryptor; Brahms AG, Hennigsdorf, Germany). NGAL was measured by turbidimetric immunoassay (NGAL Test, Bio Porto Diagnostics, Denmark). The creatinine was determined using an enzymatic IDM traced spectrophotometric method (Siemens, Healthcare Diagnostics Inc., Italy). Data were analyzed using the statistical package MedCalc 13.2.2.0. Results: NGAL values were significantly higher in sepsis than in SIRS and in patients with bacterial localized infections. The discrimination and diagnostic accuracy of NGAL were supported by ROC curve analysis. At the cut-off value of 300 ng/mL, NGAL identified sepsis with high sensitivity and specificity. In sepsis, NGAL was strictly correlated with PCT and MR-proADM. Stratifying subjects of the study population in five different classes on the basis of PCT, NGAL values were correlated with PCT in each class. NGAL, like MR-proADM, was significantly correlated with APACHE II as well as with SOFA scores of disease severity. Conclusions: Data of the study demonstrated the advantage derived from the combined use of the three markers PCT, MRproADM and NGAL in septic patients’ management and the central role of NGAL in SA-AKI diagnosis and prognosis.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
