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

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CardShock Investigators , Jäntti , T , Tarvasmäki , T , Harjola , V-P , Pulkki , K , Turkia , H , Sabell , T , Tolppanen , H , Jurkko , R , Hongisto , M , Kataja , A , Sionis , A , Silva-Cardoso , J , Banaszewski , M , DiSomma , S , Mebazaa , A , Haapio , M & Lassus , J 2021 , ' Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock ' , Annals of intensive care , vol. 11 , no. 1 , 25 . https://doi.org/10.1186/s13613-021-00814-8

Title: Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock
Author: CardShock Investigators; Jäntti, Toni; Tarvasmäki, Tuukka; Harjola, Veli-Pekka; Pulkki, Kari; Turkia, Heidi; Sabell, Tuija; Tolppanen, Heli; Jurkko, Raija; Hongisto, Mari; Kataja, Anu; Sionis, Alessandro; Silva-Cardoso, Jose; Banaszewski, Marek; DiSomma, Salvatore; Mebazaa, Alexandre; Haapio, Mikko; Lassus, Johan
Other contributor: University of Helsinki, Kardiologian yksikkö
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Emergency Medicine and Services
University of Helsinki, Department of Clinical Chemistry and Hematology
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Emergency Medicine and Services
University of Helsinki, HUS Internal Medicine and Rehabilitation
University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Heart and Lung Center












Date: 2021-02-05
Language: eng
Number of pages: 15
Belongs to series: Annals of intensive care
ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-021-00814-8
URI: http://hdl.handle.net/10138/329030
Abstract: 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-NGAL(24h) > 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.
Subject: Cardiogenic shock
Acute kidney injury
AKI
Mortality
Prognosis
Proenkephalin
PENK
NGAL
MANAGEMENT
BIOMARKER
STATEMENT
PROGNOSIS
OUTCOMES
3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
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