Medicina Intensiva  (English Edition) Medicina Intensiva  (English Edition)
Med Intensiva 2018;42:399-408 - Vol. 42 Num.7 DOI: 10.1016/j.medine.2017.12.011
Original article
Relationship between acute kidney injury and serum procalcitonin (PCT) concentration in critically ill patients with influenza infection
Relación entre disfunción renal aguda y valores séricos de procalcitonina en pacientes críticos con infección por gripe
A. Rodrígueza,, , L.F. Reyesb, J. Moncloua, B. Suberviolac, M. Bodía, G. Sirgoa, J. Solé-Violánd, J. Guardiolae, D. Barahonaf, E. Díazg, I. Martín-Loechesh, M.I. Restrepob, on behalf GETGAG study group 1
a Critical Care Department, Hospital Universitari de Tarragona Joan XXIII/IISPV/URV/CIBERes, Tarragona, Spain
b Division of Pulmonary Diseases and Critical Care Medicine University of Texas Health Science Center at San Antonio San Antonio, TX, USA
c Critical Care Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
d Critical Care Department, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain
e Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville and Robley Rex VA Medical Center, Louisville, KY, USA
f Critical Care Department, Hospital Docente de Calderón, Quito, Ecuador
g Critical Care Department, ParcTaulí Hospital/CIBERes, Sabadell, Spain
h Multidisciplinary Intensive Care Research Organization (MICRO), Department of Anaesthesia and Critical Care, St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland
Received 17 October 2017, Accepted 10 December 2017
Abstract
Introduction

Serum procalcitonin (PCT) concentration could be increased in patients with renal dysfunction in the absence of bacterial infection.

Objective

To determine the interactions among serum renal biomarkers of acute kidney injury (AKI) and serum PCT concentration, in patients admitted to the intensive care unit (ICU) due to lung influenza infection.

Design

Secondary analysis of a prospective multicentre observational study.

Setting

148 Spanish ICUs.

Patients

ICU patients admitted with influenza infection without bacterial co-infection. Clinical, laboratory and hemodynamic variables were recorded. AKI was classified as AKI I or II based on creatinine (Cr) concentrations (≥1.60–2.50mg/dL and Cr2.51–3.99mg/dL, respectively). Patients with chronic renal disease, receiving renal replacement treatment or with Cr>4mg/dL were excluded. Spearman's correlation, simple and multiple linear regression analysis were performed.

Interventions

None.

Results

Out of 663 patients included in the study, 52 (8.2%) and 10 (1.6%) developed AKI I and II, respectively. Patients with AKI were significantly older, had more comorbid conditions and were more severally ill. PCT concentrations were higher in patients with AKI (2.62 [0.60–10.0]ng/mL vs. 0.40 [0.13–1.20]ng/mL, p=0.002). Weak correlations between Cr/PCT (rho=0.18) and Urea (U)/PCT (rho=0.19) were identified. Simple linear regression showed poor interaction between Cr/U and PCT concentrations (Cr R2=0.03 and U R2=0.018). Similar results were observed during multiple linear regression analysis (Cr R2=0.046 and U R2=0.013).

Conclusions

Although PCT concentrations were slightly higher in patients with AKI, high PCT concentrations are not explained by AKI and could be warning sign of a potential bacterial infection.

Resumen
Introducción

Los niveles de procalcitonina (PCT) pueden elevarse en pacientes con disfunción renal aún en ausencia de infección bacteriana.

Objetivos

Determinar la interacción entre los biomarcadores de disfunción renal aguda (AKI) y las concentraciones séricas de PCT en pacientes ingresados en cuidados intensivos (UCI) debido a infección por gripe.

Diseño

Análisis secundario de un estudio prospectivo, multicéntrico observacional.

Lugar

Ciento cuarenta y ocho UCI.

Pacientes

Con infección por gripe sin co-infección bacteriana. Se registraron las variables clínicas, de laboratorio y hemodinámicas. El nivel de AKI fue definido como AKI I y II basado en la creatinina (Cr) sérica (>1,60-2,50mg/dl y >2,51-3,99mg/dl), respectivamente. Pacientes con insuficiencia renal crónica, técnicas de reemplazo renal o Cr>4mg/dl fueron excluidos. El análisis estadístico se realizó mediante correlación de Spearman y regresión linear simple y múltiple.

Intervenciones

Ninguna.

Resultados

De los 663 pacientes incluidos, 52 (8,2%) y 10 (1,6%) desarrollaron AKI I y II, respectivamente. Pacientes con AKI fueron más añosos, presentaron más comorbilidades y mayor nivel de gravedad. Los niveles de PCT fueron mayores en pacientes con AKI (2,62 [0,60-10,0] ng/ml vs. 0,40 [0,13-1,20] ng/ml; p=0,002). Se observaron correlaciones débiles entre Cr/PCT (rho=0,18) y PCT/U (rho=0,19). La regresión linear simple evidenció una pobre contribución tanto de Cr (R2=0,03) como de U (R2=0,018) sobre los niveles de PCT. Resultados similares fueron obtenidos con la regresión linear múltiple para Cr (R2=0,046) y U (R2=0,013).

Conclusiones

Aunque los valores de PCT pueden estar elevados en pacientes con AKI, altos niveles de PCT no pueden ser explicados por la disfunción renal y podrían ser un signo de alarma de una potencial infección bacteriana.

Keywords
Procalcitonin, Creatinine, Urea, Renal dysfunction, Influenza
Palabras clave
Procalcitonina, Creatinina, Urea, Disfunción renal, Gripe
Med Intensiva 2018;42:399-408 - Vol. 42 Num.7 DOI: 10.1016/j.medine.2017.12.011
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