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

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dc.contributor.author CardShock Investigators
dc.contributor.author Jäntti, Toni
dc.contributor.author Tarvasmäki, Tuukka
dc.contributor.author Harjola, Veli-Pekka
dc.contributor.author Pulkki, Kari
dc.contributor.author Turkia, Heidi
dc.contributor.author Sabell, Tuija
dc.contributor.author Tolppanen, Heli
dc.contributor.author Jurkko, Raija
dc.contributor.author Hongisto, Mari
dc.contributor.author Kataja, Anu
dc.contributor.author Sionis, Alessandro
dc.contributor.author Silva-Cardoso, Jose
dc.contributor.author Banaszewski, Marek
dc.contributor.author DiSomma, Salvatore
dc.contributor.author Mebazaa, Alexandre
dc.contributor.author Haapio, Mikko
dc.contributor.author Lassus, Johan
dc.date.accessioned 2021-04-14T10:38:01Z
dc.date.available 2021-04-14T10:38:01Z
dc.date.issued 2021-02-05
dc.identifier.citation 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
dc.identifier.other PURE: 162111243
dc.identifier.other PURE UUID: 32e59d74-72b8-4e21-adf4-90aa1c6e5f58
dc.identifier.other WOS: 000617435000003
dc.identifier.uri http://hdl.handle.net/10138/329030
dc.description.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. en
dc.format.extent 15
dc.language.iso eng
dc.relation.ispartof Annals of intensive care
dc.rights cc_by
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject Cardiogenic shock
dc.subject Acute kidney injury
dc.subject AKI
dc.subject Mortality
dc.subject Prognosis
dc.subject Proenkephalin
dc.subject PENK
dc.subject NGAL
dc.subject MANAGEMENT
dc.subject BIOMARKER
dc.subject STATEMENT
dc.subject PROGNOSIS
dc.subject OUTCOMES
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.subject 3121 General medicine, internal medicine and other clinical medicine
dc.title Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock en
dc.type Article
dc.contributor.organization Kardiologian yksikkö
dc.contributor.organization HUS Heart and Lung Center
dc.contributor.organization Helsinki University Hospital Area
dc.contributor.organization University of Helsinki
dc.contributor.organization Clinicum
dc.contributor.organization HUS Emergency Medicine and Services
dc.contributor.organization Department of Medicine
dc.contributor.organization Department of Clinical Chemistry and Hematology
dc.contributor.organization HUSLAB
dc.contributor.organization Department of Diagnostics and Therapeutics
dc.contributor.organization HUS Internal Medicine and Rehabilitation
dc.contributor.organization HUS Abdominal Center
dc.contributor.organization Nefrologian yksikkö
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1186/s13613-021-00814-8
dc.relation.issn 2110-5820
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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