scholarly journals The Combination of SOFA Score and Urinary NGAL May Be an Effective Predictor for Ventilator Dependence among Critically Ill Surgical Patients: A Pilot Study

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1186
Author(s):  
Hsin-I Tsai ◽  
Yu-Chieh Lu ◽  
Hao-Wei Kou ◽  
Heng-Yuan Hsu ◽  
Song-Fong Huang ◽  
...  
Keyword(s):  
Critically Ill ◽  
Sofa Score ◽  
Kidney Injury ◽  
Surgical Patients ◽  
Apache Ii Score ◽  
P Value ◽  
Urinary Ngal ◽  
Ventilator Dependence ◽  
Novel Biomarkers ◽  
Critically Ill Surgical Patients

Background: Ventilator dependence (VD) has been considered as a serious complication in critically ill patients in the intensive care unit (ICU). Acute kidney injury (AKI) is associated with VD as a result of lung–kidney interaction. The aim of our study was to investigate novel biomarkers in predicting ventilator dependence in critically ill surgical patients. Methods: Patients who were admitted to surgical ICU were enrolled and their serum and urine samples were collected. Novel biomarkers including gelatinase-associated lipocalin (NGAL), calprotectin, kidney injury molecule-1 (KIM-1), cystatin C, and growth differentiation factor 15 (GDF-15) were analyzed and correlated with clinical outcome. Results: A total of 33 patients were enrolled and analyzed. The majority of them received abdominal surgery prior to ICU admission. Thirteen patients were classified into the VD group, while the remaining 20 were in a non-ventilator dependence group (nVD). Statistical analysis demonstrated that the following were significantly higher in the VD group than in the nVD group: serum NGAL (420.25 ± 45.18 ng/mL vs. 314.68 ± 38.12 ng/mL, p-value 0.036), urinary NGAL (420.87 ± 41.08 ng/mL vs. 250.84 ± 39.45 ng/mL, p-value 0.002), SOFA score (11.3 ± 1.5 vs. 5.6 ± 0.7, p-value 0.001), and APACHE II score (23.2 ± 2.6 vs. 13.6 ± 0.8, p-value 0.001). The area under the ROC curve (AUROC) of urinary NGAL for VD was 0.808. The combination of urinary NGAL and SOFA score could further increase AUROC for VD to 0.835. Conclusions: The current study demonstrated the predictive capability of urinary NGAL for ventilator dependence among critically ill surgical patients. When combined with SOFA score, the predictive ability was further augmented. Further large-scale studies are warranted to validate our findings.

scholarly journals Prognostic Role of Ngal In Critically Ill Patients

2021 ◽  
Author(s):  
Anubhuti Bhardwaj ◽  
Ajeet Kumar Chaurasia ◽  
Poonam Gupta ◽  
Upma Narain ◽  
Arvind Gupta
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Predictive Ability ◽  
Renal Diseases ◽  
P Value ◽  
Urinary Ngal ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase ◽  
Time Of Admission

Abstract Background: Acute kidney injury (AKI) is a frequently encountered outcome in critically ill patients, accounting for increased mortality. Neutrophil gelatinase associated lipocalin (NGAL) has been of paramount importance as a novel biomarker of AKI. This study is an attempt to assess the use of NGAL in critically ill patients so that timely interventions can be done to reduce morbidity and mortality in such patients.Methods: A prospective observational study was conducted at SRN Hospital from August 1st 2020 to March 15th 2021, which included only critically ill patients with SOFA score>1 and requiring ICU admission. Patients of known renal diseases were excluded from the study. Blood as well as urinary samples for NGAL and other laboratory parameters were collected within 8 hours of admission. Patients who developed renal dysfunction were noted as our cases and the others were noted as controls. Results: The study was done on 125 patients, out of which 67 developed AKI while 58 did not develop AKI. Higher mortality was seen in patients with higher stage of AKI (P- 0.011). The cutoff of serum and urinary NGAL for predicting AKI were >42.3 ng/mL, >40.5 ng/mL respectively (P value <0.001). Hazard Ratio for all cause mortality of raised serum and urinary NGAL was 2.0062 (p value- 0.0001, 95% CI-1.0031 to 1.0092) and 2.0046 (p value-0.0035, 95% CI-1.0015 to 1.0078) respectively. Serum and urinary neutrophil gelatinase associated lipocalin at values >91 and >131 respectively were found to predict requirement of hemodialysis (p value<0.001).Conclusion: A single measurement of NGAL at the time of admission had good predictive ability for AKI. Higher values of NGAL were associated with staging of AKI and thus, correlated with need of hemodialysis. Furthermore, mortality was found to be associated with development of AKI and raised NGAL. Thus, NGAL maybe used to assess the prognosis of ICU patients so that patients at high risk may be managed aggressively, thus reducing mortality.

Late Initiation of Continuous Veno-Venous Hemofiltration Therapy is Associated with a Lower Survival Rate in Surgical Critically Ill Patients with Postoperative Acute Kidney Injury

2012 ◽  
Vol 78 (2) ◽  
pp. 235-242 ◽  
Author(s):  
Shih-Chi Wu ◽  
Chih-Yuan Fu ◽  
Hsin-Hung Lin ◽  
Ray-Jade Chen ◽  
Chi-Hsun Hsieh ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Surgical Patients ◽  
Lower Survival Rate ◽  
Late Initiation ◽  
Late Group ◽  
Critically Ill Surgical Patients

There is controversy about the appropriate timing for renal replacement therapy in patients with acute kidney injury (AKI). We are interested in the appropriate timing for initiation of continuous renal replacement therapy in critically ill surgical patients with postoperative acute kidney injury. Seventy-three critically ill surgical patients with postoperative AKI who received continuous renal replacement therapy (CRRT) were enrolled. Indications for CRRT were: 1) AKI with hyperkalemia, 2) metabolic acidosis, 3) pulmonary edema refractory to diuretics, and 4) oliguria with progressive azotemia, especially in unstable hemodynamics. Using RIFLE (Risk, Injury, Failure, Loss, End stage) classification, patients who received CRRT in the “Risk” stage were defined as early group, whereas those in the “Injury/ Failure” stage were labeled as late group. We used continuous veno-venous hemofiltration as CRRT in this series. There were 20 patients in the early group and 53 patients in the late group. The mean ages were 61.5 ± 21.8 years versus 60.8 ± 17.5 years. The mortality rate was 50 per cent versus 84.9 per cent. There were no significant differences in demographic characteristics or type of surgery or physiological scores. Our data show that late initiation of CRRT is associated with a lower survival rate in critically ill surgical patients with postoperative AKI; however, further studies are required.

Epidemiology and outcomes of acute kidney injury in critically ill surgical patients

2015 ◽  
Vol 30 (1) ◽  
pp. 102-106 ◽  
Author(s):  
Donald G. Harris ◽  
Michelle P. McCrone ◽  
Grace Koo ◽  
Adam S. Weltz ◽  
William C. Chiu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Surgical Patients ◽  
Critically Ill Surgical Patients

Acute kidney injury in critically ill surgical patients: Epidemiology, risk factors and outcomes

Nephrology ◽  
2018 ◽  
Vol 24 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Konlawij Trongtrakul ◽  
Chaiwut Sawawiboon ◽  
Amanda Y Wang ◽  
Anusang Chitsomkasem ◽  
Ploynapas Limphunudom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Surgical Patients ◽  
Critically Ill Surgical Patients

scholarly journals External Validation of the Acute Kidney Injury Risk Prediction Score for Critically Ill Surgical Patients Who Underwent Major Non-Cardiothoracic Surgery

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 209
Author(s):  
Konlawij Trongtrakul ◽  
Jayanton Patumanond ◽  
Piyarat Phairatwet ◽  
Chaiwut Sawawiboon ◽  
Anusang Chitsomkasem ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
External Validation ◽  
Kidney Injury ◽  
Cardiothoracic Surgery ◽  
Clinical Usefulness ◽  
Prediction Score ◽  
Surgical Patients ◽  
Discriminative Ability ◽  
Critically Ill Surgical Patients

Background: Acute kidney injury (AKI) is a common complication encountered in an intensive care unit (ICU). In 2020, the AKI prediction score was developed specifically for critically ill surgical patients who underwent major non-cardiothoracic surgeries. This study aimed to externally validate the AKI prediction score in terms of performance and clinical utility. Methods: External validation was carried out in a prospective cohort of patients admitted to the ICU of the Faculty of Medicine Vajira Hospital between September 2014 and September 2015. The endpoint was AKI within seven days following ICU admission. Discriminative ability was based on the area under the receiver operating characteristic curves (AuROC). Calibration and clinical usefulness were evaluated. Results: A total of 201 patients were included in the analysis. AKI occurred in 37 (18.4%) patients. The discriminative ability dropped from good in the derivation cohort, to acceptable in the validation cohort (0.839 (95%CI 0.825–0.852) vs. 0.745 (95%CI 0.652–0.838)). No evidence of lack-of-fit was identified (p = 0.754). The score had potential clinical usefulness across the range of threshold probability from 10 to 50%. Conclusions: The AKI prediction score showed an acceptable discriminative performance and calibration with potential clinical usefulness for predicting AKI risk in surgical patients who underwent major non-cardiothoracic surgery.

Sign in / Sign up

Export Citation Format

Share Document