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-NGAL24h > 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.

Trial registration: NCT01374867 at www.clinicaltrials.gov, registered 16 Jun 2011—retrospectively registered

Details

Title
Predictive value of plasma proenkephalin and neutrophil gelatinase-associated lipocalin in acute kidney injury and mortality in cardiogenic shock
Author
Jäntti Toni 1   VIAFID ORCID Logo  ; Tarvasmäki Tuukka 1 ; Veli-Pekka, Harjola 2 ; Pulkki Kari 3 ; Turkia Heidi 3 ; Sabell Tuija 4 ; Tolppanen Heli 4 ; Jurkko Raija 4 ; Hongisto Mari 5 ; Kataja Anu 6 ; Sionis Alessandro 7 ; Silva-Cardoso, Jose 8 ; Banaszewski Marek 9 ; DiSomma Salvatore 10 ; Mebazaa Alexandre 11 ; Haapio Mikko 12 ; Lassus Johan 13 ; Køber Lars 13 ; Metra Marco; Parissis, John; Di Somma Salvatore; Spinar Jindrich; Koniari Katerina; Voumvourakis Astrinos; Karavidas Apostolos; Sans-Rosello Jordi; Vila Montserrat; Duran-Cambra, Albert; Bulgari Michela; Lazzarini Valentina; Parenica Jiri; Stipal Roman; Ludka Ondrej; Palsuva Marie; Ganovska Eva; Kubena Petr; Lindholm, Matias G; Hassager, Christian; Bäcklund, Tom; Järvinen Kristiina; Nieminen Tuomo; Soininen Leena; Sund Reijo; Tierala Ilkka; Tolonen Jukka; Varpula Marjut; Korva Tuomas; Pitkälä Anne; Marino, Rossella; Sousa, Alexandra; Sousa, Carla; Paiva, Mariana; Rangel Inês; Almeida, Rui; Pinho, Teresa; Maciel, Maria Júlia; Stepinska Janina; Skrobisz Anna; Góral Piotr

1  Helsinki University Hospital, University of Helsinki, Department of Cardiology, Heart and Lung Center, Helsinki, Finland 
2  Helsinki University Hospital, University of Helsinki, Emergency Medicine, Department of Emergency Medicine and Services, Helsinki, Finland 
3  Helsinki University Hospital and University of Helsinki, HUSLAB Diagnostic Services, Helsinki, Finland (GRID:grid.15485.3d) (ISNI:0000 0000 9950 5666) 
4  Helsinki University Hospital, University of Helsinki, Department of Cardiology, Heart and Lung Center, Helsinki, Finland (GRID:grid.15485.3d) 
5  Helsinki University Hospital, University of Helsinki, Emergency Medicine, Department of Emergency Medicine and Services, Helsinki, Finland (GRID:grid.15485.3d) 
6  University of Helsinki, Internal Medicine, Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland (GRID:grid.7737.4) (ISNI:0000 0004 0410 2071) 
7  Universidad Autónoma de Barcelona, Intensive Cardiac Care Unit, Cardiology Department, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute IIB‐SantPau, Barcelona, Spain (GRID:grid.7080.f) 
8  University of Porto, CINTESIS, Department of Cardiology, São João Hospital Center, and Porto Medical School, Porto, Portugal (GRID:grid.5808.5) (ISNI:0000 0001 1503 7226) 
9  National Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland (GRID:grid.418887.a) 
10  University of Rome Sapienza, Department of Medical Sciences and Translational Medicine, Sant’Andrea Hospital, Rome, Italy (GRID:grid.7841.a) 
11  University Paris Diderot, INSERM U942, Department of Anesthesia and Critical Care, Hôpital Lariboisière, APHP, Paris, France (GRID:grid.508487.6) (ISNI:0000 0004 7885 7602) 
12  Helsinki University Hospital, University of Helsinki, Nephrology, Department of Nephrology, Abdominal Center, Helsinki, Finland (GRID:grid.508487.6) 
13  Helsinki University Hospital, University of Helsinki, Department of Cardiology, Heart and Lung Center, Helsinki, Finland (GRID:grid.508487.6) 
Publication year
2021
Publication date
Feb 2021
Publisher
Springer Nature B.V.
e-ISSN
21105820
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s13613-021-00814-8
ProQuest document ID
2486623402
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.