EVALUATION OF INFLAMMATORY MARKERS IN CRITICALLY ILL ICU PATIENTS WITH AND WITHOUT ACUTE KIDNEY INJURY

Objective: Acute Kidney Injury (AKI) is a prevalent condition among patients admitted to the intensive care unit (ICU), with high incidence and increased mortality rates. AKI often induces the elevation of inflammatory biomarkers used for diagnosing infection. This study aimed to investigate changes in inflammatory markers in the setting of AKI. Methods: This retrospective study included patients admitted to the ICUs of Burdur State Hospital between January 2019 and January 2023. Data from 958 patients were analyzed, and AKI was classified by the Acute Kidney Injury Network (AKIN) criteria. Only creatinine data were used as information on urine output was not available. The cohort was stratified into following groups: no AKI (AKI 0), b) creatine levels between 1.60 and 2.50 mg/dL (AKI I), creatine levels between 2.51 and 3.99 mg/dL (AKI II), and creatine levels above 4 and receiving renal replacement therapy (AKI III). Results: Of the 958 patients, male and female distribution was 55.1% (n= 528) and 44.9% (n= 430) respectively. The median age of the study cohort was 79 years (IQR=18.3 years). Neutrophil-to-lymphocyte ratio, procalcitonin, and C-reactive protein levels were found to increase significantly in direct relation to the severity of AKI (p<0.001). Furthermore, in infected patients, these inflammatory biomarkers were found to increase in parallel with the severity of AKI compared to non-infected patients (p<0.001). Conclusion: Inflammatory biomarkers rise as the severity of renal failure increases. The combined use of neutrophil-to-lymphocyte ratio, procalcitonin, and C-reactive protein levels in patients with renal failure would be more effective for diagnosing infection.

Keywords:

Infection, Inflammatory Biomarker Renal Failure, Intensive Care,

PDF

___

Singh TB, Rathore SS, Choudhury TA, Shukla VK, Singh DK, Prakash J. Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study. Indian J Nephrol 2013;23:24-9.
Case J, Khan S, Khalid R, Khan A. Epidemiology of Acute Kidney Injury in the Intensive Care Unit, Crit Care Res Pract 2013;2013:479730.
Whicher J,Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin Biochem .2001;38:483-93.
Rebello A, Thabah MM, Dutta TK, Bobby Z, Harrish BN, Mehalingam V. Procalcitonin levels in sepsis and its association with clinical outcome in southern India. Tropical Doctor. 2017;47:331-6.
Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents. 2002;20:1-9.
Smith RP, Lipworth BJ. C-reactive protein in simple community acquired pneumonia. Chest. 1995;107:1028-31
Hamm CW, Nef HM, Rolf A, Möllmann H. Calcium and C-reactive protein. J Am Coll Cardiol. 2011;57:465-7
Zahorec R. Ratio neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5–14.
Jılma B, Blann A, Pernerstorfer T, et al. Regulation of adhesion molecules during human endotoxemia. Am J Respir Crit Care Med 1999;159:857–63.
Nakamura Y, Murai A, Mizunuma M, et al. Potential use of procalcitonin as biomarker for bacterial sepsis in patients with or without acute kidney injury. J Infect Chemother.2015; 21:257-63.
Cosentino N , Genovese S , Campodonico J ,et al. High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study. J. Clin. Med. 2019;8: 2192.
Erdem E. Neutrophil lymphocyte ratio in aute renal failure. Indian J Nephrol. 2015; 25: 126–7.
Rodríguez A , Reyes L.F, Monclou J, et al. Relationship between acute kidney injury and serum procalcitonin (PCT) concentration in critically ill patients with influenza infection. Med Intensiva. 2018;42:399-08
Mas-Font, S,Ros-Martinez, J, Perez-Calvo, et al. Prevention of acute kidney injury in Intensive Care Units. Med. Intensiva 2017;41: 116-26.
Chun K, Chung W, Kim A.J ,et al . Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients. Sci. Rep. 2019;9: 4777.
Carrigan S.D, Scott G, Tabrizian M. Toward resolving the challenges of sepsis diagnosis, Clin. Chem. 2004:50;1301-14.
Dahaba AA, Rehak PH, List WF. Procacitonin and C-reactive protein plasma concentrations in nonseptic uremic patients undergoing hemodialysis. Intensive Care Med. 2003;29:579–83.
Meisner M, Lohs T, Huettemann E, Schmidt J, Hueller M, Reinhart K. The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function. Eur J Anaesthesiol 2001;18:79e87.
Herget-Rosenthal S , Marggraf G, Pietruck F,et al. Procalcitonin for accurate detection of infection in haemodialysis. Nephrol Dial Transplant.2001; 16: 975–9.
Castelli GP, Pognani C, Meisner M, Stuani A, Bellomi D, Sgarbi L. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care 2004;8:R234-42.
Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004;39:206 217.
Park JH , Kim DH , Jang HR, et al.Clinical relevance of procalcitonin and C-reactive protein as infection markers in renal impairment: a cross-sectional study. Critical Care 2014, 18:640.
Heredia-Rodriguez M, Bustamante-Munguira J, Fierro I, et al. Procalcitonin cannot be used as a biomarker of infection in heart surgery patients with acute kidney injury. J. Crit. Care 2016;33:233-39
Huang HL, Nie X, Cai B, et al. Procalcitonin Levels Predict Acute Kidney Injury and Prognosis in Acute Pancreatitis: A Prospective Study. PLoS ONE 2013; 8: e82250.
Benschop RJ, Rodriguez-Feuerhahn M, Schedlowski M Catecholamine-induced leukocytosis: early observations, current research, and future directions. Brain Behav Immun. 1996; 10:77–91.
Chen JJ, Kuo G , Fan PC, et al. Neutrophil‑to‑lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: a population‑based, multi‑institutional study. Journal of Nephrology 2022;35:911–20
Bi JB, Zhang J, Ren YF, et al. Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery. World J Gastrointest Surg. 2020 ; 12: 326-35.