Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants Selection
2.2. Measurements
2.3. Quantitative Measurement of Biomarkers
2.4. Statistical Analysis
3. Results
3.1. Basic Characteristics and Clinical Variables of the Two Groups
3.2. The Association among Infection, Acute Kidney Injury and Impaired Renal Function
3.3. The Predictive Ability of Serum Procalcitonin for Acute Kidney Injury
4. Discussion
4.1. Influence on Procalcitonin: Infection, Residual Renal Function and Acute Kidney Injury
4.2. Influence on Procalcitonin: Acute Kidney Injury vs. Infection
4.3. Influence on Procalcitonin: Acute Kidney Injury vs. Chronic Kidney Disease
4.4. Serum Procalcitonin as a Predictor for Acute Kidney Injury
4.5. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Total (n = 330) | Non-AKI Group (n = 203) | AKI Group (n = 127) | p-Value | |
---|---|---|---|---|
Basic demographic data | ||||
Age | 70.5 ± 16.4 | 70.5 ± 16.5 | 70.6 ± 16.3 | 0.933 |
Gender, male | 188 (57.0%) | 119 (58.6%) | 69 (54.3%) | 0.444 |
Smoker | 72 (21.8%) | 42 (20.7%) | 30 (23.6%) | 0.752 |
Undertaking oral antibiotics | 19 (5.8%) | 13 (6.4%) | 6 (4.7%) | 0.524 |
Body mass index | 21.9 ± 5.7 | 22.1 ± 5.5 | 21.5 ± 5.9 | 0.351 |
Comorbidities | ||||
Coronal artery disease | 73 (22.1%) | 48 (23.6%) | 25 (19.7%) | 0.399 |
Congestive heart failure | 47 (14.2%) | 29 (14.3%) | 18 (14.2%) | 0.977 |
Peripheral artery occlusive disease | 8 (2.4%) | 5 (2.5%) | 3 (2.4%) | 0.954 |
Cerebral vascular accident | 104 (31.5%) | 61 (30%) | 43 (33.9%) | 0.469 |
Chronic lung disease | 82 (24.8%) | 51 (25.1%) | 31 (24.4%) | 0.884 |
Chronic kidney disease | 98 (29.7%) | 56 (27.6%) | 42 (33.1%) | 0.289 |
Diabetes mellitus | 131(39.7%) | 80 (39.4%) | 51 (40.2%) | 0.892 |
Cancer | 44 (13.3%) | 24 (11.8%) | 20 (15.7%) | 0.307 |
Liver cirrhosis | 28 (8.5%) | 16 (7.9%) | 12 (9.4%) | 0.619 |
Hypertension | 189 (57.3%) | 115 (56.7%) | 74 (58.3%) | 0.773 |
Charlson’s score, points | 3.8 ± 2.6 | 3.7 ± 2.6 | 3.9 ± 2.6 | 0.460 |
Culture-proven infection | 173 (52.4%) | 103 (50.7%) | 70 (55.1%) | 0.438 |
Infection source | ||||
Pneumonia | 52 (15.8%) | 25 (12.3%) | 27 (21.3%) | 0.030 |
Urinary tract infection | 65 (19.7%) | 40 (19.7%) | 25 (19.7%) | 0.997 |
Bloodstream infection | 72 (21.8%) | 38 (18.7%) | 34 (26.8%) | 0.085 |
Skin infection | 13 (3.9%) | 9 (4.4%) | 4 (3.1%) | 0.560 |
Other source | 45 (13.6%) | 28 (13.8%) | 17 (13.4%) | 0.916 |
Clinical variables at ICU admission | ||||
Body temperature, °C | 36.5 ± 1.2 | 36.6 ± 1.1 | 36.4 ± 1.2 | 0.135 |
Heart rate, beat/min | 103 ± 24.4 | 101.9 ± 24.9 | 104.9 ± 23.5 | 0.282 |
Respiratory rate, breath/min | 25.1 ± 9.1 | 24.7 ± 9.5 | 25.6 ± 8.6 | 0.363 |
Mean arterial pressure, mmHg | 89.0 ± 25.5 | 89.9 ± 25.5 | 87.5 ± 25.6 | 0.415 |
Glasgow coma scale, points | 10.3 ± 4.5 | 10.1 ± 4.6 | 10.7 ± 4.4 | 0.280 |
APACHE II, points | 20.8 ± 8.2 | 20.1 ± 8.4 | 21.9 ± 7.9 | 0.051 |
SOFA score, points | 6.9 ± 3.8 | 6.2 ± 3.8 | 8.1 ± 3.6 | <0.001 |
With ventilator | 99 (30.0%) | 63 (31.0%) | 36(28.3%) | 0.604 |
With NIPPV | 88 (26.7%) | 53 (26.1%) | 35(27.6%) | 0.772 |
With vasopressor | 112 (33.9%) | 61 (30.0%) | 51(40.2%) | 0.059 |
Underwent CPR | 29 (8.8%) | 17(8.4%) | 12(9.4%) | 0.737 |
30-days mortality | 81 (24.5%) | 41 (20.2%) | 40 (31.5%) | 0.020 |
Total (n = 330) | Non-AKI Group (n = 203) | AKI Group (n = 127) | p-Value | |
---|---|---|---|---|
Procalcitonin, ng/mL | 0.8 (0.02, 242.8) | 0.5 (0.02, 242.8) | 2.3 (0.05, 234.6) | <0.001 |
White blood cell, ×103/mL | 13.5 ± 8.7 | 12.8 ± 7.4 | 14.6 ± 10.4 | 0.057 |
Neutrophil/ Lymphocyte ratio | 8.3 (0.2, 95.8) | 7.0 (0.2, 95.8) | 10.4 (0.2, 91.8) | 0.068 |
Hemoglobin, g/dL | 11.1 ± 2.9 | 11.2 ± 3.0 | 10.8 ± 2.8 | 0.321 |
Platelet, ×103/mL | 216.7 ± 114.0 | 219.8 ± 116.6 | 211.6 ± 110.1 | 0.527 |
Blood urea nitrogen, mmol/L | 32.2 (5.3, 210.7) | 23.4 (5.3, 210.7) | 54.4 (11.0, 205.0) | <0.001 |
sCr, mmol/L | 1.5 (0.3, 18.2) | 1.0 (0.3, 15.9) | 2.6 (0.4, 18.2) | <0.001 |
eGFR, ml/min/1.73 m2 | 44.2 (1.3, 557.8) | 65.9 (1.3, 382.3) | 23.5 (1.8, 557.8) | <0.001 |
AST, units/L | 32.0 (3.4, 2236.0) | 29.0 (9.0, 2236.0) | 41.0 (3.4, 1027.0) | 0.067 |
ALT, units/L | 25.0 (1.0, 1891.0) | 21.0 (1.0, 709.0) | 36.0 (3.0, 1891.0) | 0.002 |
Sodium, mmol/L | 136.8 ± 9.2 | 136.7 ± 8.3 | 137.0 ± 10.6 | 0.806 |
Potassium, mEq/L | 4.2 ± 1.1 | 4.1 ± 1.0 | 4.4 ± 1.2 | 0.031 |
Calcium, mEq/L | 8.3 ± 1.0 | 8.3 ± 1.0 | 8.3 ± 1.1 | 0.967 |
PH | 7.3 ± 0.1 | 7.4 ± 0.1 | 7.3 ± 0.1 | 0.512 |
HCO3, mEq/L | 19.8 ± 7.8 | 21.2 ± 7.8 | 17.5 ± 7.4 | <0.001 |
Glucose, mg/dl | 225.1 ± 170.9 | 209.6 ± 132.9 | 249.8 ± 216.7 | 0.062 |
Albumin, mg/dl | 3.1 ± 0.6 | 3.1 ± 0.6 | 3.0 ± 0.6 | 0.144 |
Bililubin (total), mg/dl | 0.9 (0.0, 42.5) | 0.9 (0.1, 15.0) | 0.9 (0.0, 42.5) | 0.210 |
Baseline SCr, mmol/L | 1.0 (0.2, 11.2) | 1.0 (0.2, 11.2) | 1.0 (0.2, 10.6) | 0.056 |
Delta SCr, mmol/L | 0.9 ± 2.2 | 0.0 ± 0.9 | 2.4 ± 2.7 | <0.001 |
Ratio of SCr | 1.8 ± 1.6 | 1.0 ± 0.3 | 3.0 ± 2.1 | <0.001 |
Multivariate Logistic Regression | |||
---|---|---|---|
Odds Ratio | 95% Confidence Interval | p-Value | |
Total cohort (n = 330) | 1.27 | 1.12–1.43 | <0.001 |
Non-infection group (n = 157) | 1.38 | 1.12–1.71 | 0.003 |
Infection group (n = 173) | 1.23 | 1.03–1.46 | 0.020 |
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Huang, Y.-T.; Lai, M.-Y.; Kan, W.-C.; Shiao, C.-C. Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients. J. Clin. Med. 2020, 9, 1939. https://doi.org/10.3390/jcm9061939
Huang Y-T, Lai M-Y, Kan W-C, Shiao C-C. Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients. Journal of Clinical Medicine. 2020; 9(6):1939. https://doi.org/10.3390/jcm9061939
Chicago/Turabian StyleHuang, Ya-Ting, Min-Yu Lai, Wei-Chih Kan, and Chih-Chung Shiao. 2020. "Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients" Journal of Clinical Medicine 9, no. 6: 1939. https://doi.org/10.3390/jcm9061939