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Introducción: hasta el 60 % de los pacientes con sepsis desarrollan daño renal agudo. La procalcitonina indica la presencia de sepsis y puede predecir un daño renal agudo.
Objetivos: determinar los valores de procalcitonina como biomarcador predictor de daño renal agudo y sus complicaciones en el espectro de sepsis.
Métodos: estudio transversal. Se midió procalcitonina durante las 24 horas de hospitalización. Se determinó el área bajo la curva, el error estándar, la sensibilidad y especificidad de los valores de procalcitonina relacionado con daño renal agudo.
Resultados: un total de 72 pacientes con edad de 51 años (rango 18 –79); 35 (48,6 %) casos eran hombres, 44 (61,1 %) presentaron sepsis, 14 (19,4 %) choque séptico, 11 (15,3 %) sepsis severa y 3 (4,2 %) hipotensión inducida por sepsis. Encontramos una elevación de procalcitonina (>0,5 ng/mL) en 54 (75 %) pacientes; presentaron daño renal agudo 42 (58,3 %) casos; estadio KDIGO 1 en 19 (45,2 %), KDIGO 2 en 12 (28,6 %) y KDIGO 3 en 11 (26,2 %) pacientes; de ellos 37 (88,1 %) presentaron procalcitonina >0,5 ng/mL (OR 5,65, IC 95 % 1,73 – 18,42; p<0,01). El área debajo de la curva 0,75 (IC 95 % 0,63 – 0,86 p <0,0001); el valor de procalcitonina de 2,565 ng/mL tuvo la mayor validez prediciendo daño renal agudo, con sensibilidad de 61,9 %, especificidad de 80 %, un valor predictivo positivo de 44,52 %, valor predictivo negativo de 56,18 %, LR+ de 0.80 y un LR- de 0.77.
Conclusion: en el espectro de sepsis, el nivel de procalcitonina >2,565 ng/mL al ingreso hospitalario predice daño renal agudo.
Citas
Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clin Pract. 2012; 7,120(4):179-184. https://doi.org/10.1159/000339789
Cartin-Ceba R, Haugen EN, Iscimen R, Trillo-Alvarez C, Juncos L, Gajic O. Evaluation of “Loss” and “End stage renal disease” after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients. Intensive Care Med. 2009;35:2087-95. https://doi.org/10.1007/s00134-009-1635-9
Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem?. Crit Care Med. 2008; 36(4 Suppl):S146-51. https://doi.org/10.1097/CCM.0b013e318168c590
Suh SH, Kim CS, Choi JS, Bae EH, Ma SK, Kim SW. Acute kidney injury in patients with sepsis and septic shock: risk factors and clinical outcomes. Yonsei Med J. 2013;54(4):965-72. https://doi.org/10.3349/ymj.2013.54.4.965
Kelly KJ. Acute renal failure: much more than a kidney disease. Semin Nephrol.2006;26:105-113. https://doi.org 10.1016/j.semnephrol.2005.09.003
Siew ED, Peterson JF, Eden SK, Hung AM, Speroff T, Ikizler TA, et al. Outpatient nephrology referral rates after acute kidney injury. J Am Soc Nephrol. 2012; 23:305-312. https://doi.org/10.1681/ASN.2011030315
Landry DW, Oliver JA. The pathogenesis of vasodilatory shock. N Engl J Med. 2001;345:588-95. https://doi.org 10.1056/NEJMra002709
Zarjou A, Agarwal A. Sepsis and acute kidney injury. J Am Soc Nephrol. 2011;22(6):999-1006. https://doi.org/10.1681/ASN.2010050484
Schrier RW, Wang W. Acute Renal Failure and Sepsis. N Engl J Med. 2004; 351(2):159-69. https://doi.org/10.1056/NEJMra032401
Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P. Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The French Study Group on Acute Renal Failure. Nephrol Dial Transplant. 1996;11(2):293-9. https://doi.org/10.1093/oxfordjournals. ndt.a027256
Al-Nawas B, Kramer I, Sha PM. Procalcitonin in the diagnosis of severe infections. Eur J Med Res.1996;1(7):331-333.
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet.1993;341(8844):515-518. https://doi.org/10.1016/0140-6736(93)90277-n
Herget-Rosenthal S, Marggraf G, Pietruck F, Hüsing J, Strupat M, Philipp T, et al. Procalcitonin for accurate detection of infection in haemodialysis. Nephrol Dial Transplant. 2001;16(5):975-979. https://doi.org/10.1093/ndt/16.5.975
Steinbach G, Bölke E, Grünert A, Storck M, Orth K. Procalcitonin in patients with acute and chronic renal insufficiency. Wien Klin Wochenschr (2004);116(24):849-853.
Nishikura T. The clearance of procalcitonin (PCT) during continuous veno-venous haemodiafiltration (CVVHD) [Letter]. Intens Care Med.1999;25:1198-1199.
Rau B, Steinbach G, Baumgart K, Gansauge F, Grunert A, Beger HG. The clinical value of procalcitonin in the prediction of infected necrosis in acute pancreatitis. Intensive Care Med. 2000; 26(Suppl 2):S159-64. https://doi.org/ 10.1007/BF02900730
Araujo M, Doi SQ, Palant CE, Nylen ES, Becker KL. Procalcitonin induced cytotoxicity and apoptosis in mesangial cells: implications for septic renal injury. Inflamm Res. 2013(62):887-894. https://doi.org/10.1007/s00011-013-0646-8
Dellinger P, Levy M, Rhodes A, Annane D, Gerlach H, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Crit Care Med. 2013;41(2):580-637. https://doi.org/10.1097/CCM.0b013e31827e83af.
KDIGO Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for acute kidney injury. Kidney Inter. 2012;2(Suppl):1-138.
Becker Kl, Snider R, Nylen Es. Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target. Br J Pharmacol. 2010;159(2):253-64. https://doi.org/10.1111/j.1476-5381.2009.00433.x
Nie X, Wu B, He Y, Huang X, Dai Z, Luo T, et al. Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection. Clin Chem Lab Med. 2013;15(8):1655-61. https://doi.org/10.1515/cclm-2012-0822
Nakamura Y, Murai A, Mizunuma M, Ohta D, Kawano Y, Matsumoto N, et al. Potential use of procalcitonin as biomarker for bacterial sepsis in patients with or without acute kidney injury. J Infect Chemother. 2015;21(4):257-63. https://doi.org/10.1016/j.jiac.2014.12.001
Liu Y, Guo W, Zhang J, Xu C, Yu S, et al. Urinary interleukin 18 for detection of acute kidney injury: a meta-analysis. Am J Kidney Dis. 2013;62(6):1058-67. https://doi.org/10.1053/j.ajkd.2013.05.014
Susantitaphong P, Siribamrungwong M, Doi K, Noiri E, Terrin N, Jaber BL. Performance of urinary liver-type fatty acid-binding pro tein in acute kidney injury: a meta-analysis. Am J Kidney Dis. 2013;61(3):430-9. https://doi.org/10.1053/j.ajkd.2012.10.016
Zhang A, Cai Y, Wang PF, Qu JN, Luo zc, Chen XD, et al. Diagnosis and prognosis of neutrophil gelatinase-associated lipocalin for acute kidney injury with sepsis: a systematic review and meta-analysis. Critical Care. 2016;20:41. https://doi.org/10.1186/s13054-016-1212-x
Kellum JA, Chawla LS. Cell-cycle arrest and acute kidney injury: the light and the dark sides. Nephrol Dial Transplant. 2016; 31(1):16-22. https://doi.org/10.1093/ndt/gfv130.
Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH, Celik IE, et al. Procalcitonin as an Early Predictor of Contrast Induced Acute Kidney Injury in Patients With Acute Coronary Syndromes Who Underwent Percutaneous Coronary Intervention. Angiology. 2015;66(10):957-63. https://doi.org/10.1177/0003319715572218
Huang HL, Nie X, Cai B, Tang JT, He Y, et al. Procalcitonin levels predict acute kidney injury and prognosis in acute pancreatitis: a prospective study. PLoS One. 2013;8(12). https://doi.org/10.1371/journal.pone.0082250
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