Avaliação dos biomarcadores ngal, cistatina C e IL-18 no sangue e urina de pacientes sépticos com e sem lesão renal aguda.

• Autor(a) principal: Caltabiano, Regina Helena Lima [UNIFESP]
• Data de Publicação: 2018
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6416069; https://repositorio.unifesp.br/handle/11600/53151
• topic: Sepse; Lesão renal aguda; Lipocalina; Interleucina- 1 5 cistatina C; Sepse; Lesão renal aguda; Lipocalina; Interleucina- 1 5 cistatina C

Sepsis has long been recognized as a foremost precipitant of acute kidney injury (AKI) in critically ill patients treated in Intensive Care Units (ICU), with poor outcomes, high mortality and longer hospitalization time. The later diagnosis of AKI based on serum creatinine changes and urine output is an important point to this poor outcome. Biomarkers have been showing to be an effective method to detect early AKI, to predict the progression of AKI, and the need of renal replacement therapy (RRT) in critically ill patients, guiding a preventive treatment and early dialysis, for more positive outcome. Objectives: Evaluate how Neutrophil gelatinase-associated lipocalin (NGAL) plasma(p) and urinary(u); Cystatin C plasma; and Interleukin-18 urinary (IL- 18u) react due to different classifications of AKI, AKI diagnosis, need to perform renal replacement therapy and mortality in critically ill patients in ICU with severe sepsis and septic shock. Methods: Prospective cohort, 40 patients that were in the ICU were recruited, 11 were diagnosed with severe sepsis, and 29 with septic shock, based on the consensus definition from 1992. AKI classification was used RIFLE and AKIN daily since enrollment in the study. To detect biomarkers ELISA method was used. Results: To differentiate patients with and without kidney injury by AKIN classification on the day of enrollment in the study, the biomarkers showed the following results: NGALp - Odds Ratio (OR) 5,6 (p=0,055) and AUROC 0,70, NAGLu - OR 11,9 (p=0,03) and AUROC 0,73, Cystatin C plasma - OR 6,86 (p=0,089) and AUROC 0,67, IL-18 urinary - OR 8,73 (p=0,059) and AUROC 0,72; by RIFLE diuresis classification on the day of enrollment in the study: NGALp - OR 3,5 (p=0,118), NGALu - OR 28 (p=0,001) and AUROC 0,82, Cystatin C plasma - OR 6,0 (p=0,028) and AUROC 0,57, IL-18u - OR 5,4 (p= 0,058) and AUROC 0,71; by RIFLE of creatinine classification on the day of enrollment in the study: NGALp – OR 3,61 (p=0,080) and AUROC 0,65, NGALu - OR 4,06 (p=0,059) and AUROC 0,60, Cystatin C plasma - OR13 (p=0,022) and AUROC 0,72, IL18u - OR 2,33 (p=0,242) and AUROC 0,51. When analyzing hemodialysis prediction on the day of enrollment in the study, the biomarkers showed the following results: NGALp OR 11,9 (p=0,03) and AUROC 0,69, NGALu OR 36 (p=0,001) and AUROC 0,81, Cystatin C OR 24 (p=0,002) and AUROC 0,80, IL-18u OR 6,38 (p=0,045) and AUROC 0,74. When analyzing hemodialysis prediction after 24 hours of pacient enrollment: NGALp OR 15,75 and AUROC 0,80, NGALu AUROC 0,90, Cystatin C OR 5,5 (p=0,056) and AUROC 0,70, IL-18u OR 14 (p=0,029) and AUROC 0,76. Related outcomes prediction only NGALp 24 hours of patient enrollment showed significant AUROC 0,72 to mortality. Conclusion: the three biomarkers investigated in the study NGAL plasma and urinary, Cystatin C plasma, and IL-18 urinary, showed to be able to differentiate patients with sepsis with and without AKI and showed to be an effective method to predict hemodialysis in this population with sepsis. The only biomarker associate with mortality was NGALp after 24 hours of patient enrollment.