Kinetic changes in serum procalcitonin predict persistent acute kidney injury in critical patients.

PURPOSE: Persistent acute kidney injury (AKI) has been shown to be closely associated with poor prognosis in critical patients. Recent studies have shown that procalcitonin (PCT) is valuable for the early prediction of AKI in critically patients. Our aim was to determine whether PCT and its kinetic changes could predict the occurrence of persistent AKI in critical patients. METHODS: This is a prospective observational study. The definition of AKI was based on the Kidney Disease: Improving Global Outcomes criteria. Persistent AKI was defined as renal function that does not return to baseline serum creatinine levels within 48 h. Blood samples were obtained at the onset of AKI and two subsequent days of hospital stay. 24-h PCT change (ΔPCT-24 h) was defined as 24 h PCT minus baseline PCT (day 0). RESULTS: A total of 91 critical patients with AKI were included in this study. The persistent AKI group had a stepwise increase in PCT concentration. ΔPCT-24 h was higher in the persistent AKI group (p < .01). Logistic regression analysis showed that ΔPCT-24 h (p = .04) was independent predictors of persistent AKI. The receiver operating characteristic curves showed that area under the curve of ΔPCT-24 h was 0.84 (p < .01), and the cut-off value for PCT to predict persistent AKI was 0.56 ng/ml. CONCLUSION: Our study showed that the observation of kinetic changes in PCT is more significant for the early prediction of persistent AKI than the index of PCT at a single time point. ΔPCT-24 h is a good predictor of persistent AKI in critical patients.

[Effects of penehyclidine hydrochloride on the splanchnic perfusion of patients with septic shock].

OBJECTIVE: To observe the effect of penehyclidine hydrochloride on the treatment of septic shock. METHODS: Forty-five patients with a confirmed diagnosis of septic shock were enrolled, and they were randomly and equally divided into 3 groups, namely penehyclidine hydrochloride group, anisodamine group and control group (each n=15). Gastric intramucosal carbon dioxide partial pressure (PgCO2) was determined by gastric mucosa tonometry, partial pressure of carbon dioxide in arterial blood (PaCO2) was determined by blood gas analysis and then gastric-arterial carbon dioxide partial pressure gap [P(g-a) CO2] was calculated prior to medication (0 hour) and 1, 6, 12 and 24 hours after medication respectively. The heart rate, mean arterial pressure (MAP), central venous pressure (CVP), urine volume, central venous oxygen saturation (ScvO2) and prognosis were observed. RESULTS: Compared with control group, P(g-a) CO2 decreased significantly (P<0.05, respectively) at each time point after medication, whereas no significant difference in MAP or CVP was seen between penehyclidine hydrochloride group and anisodamine group. No marked change in heart rate was found in penehyclidine hydrochloride group, but it increased significantly in anisodamine group (P<0.05). The number of patients that attained the traditional goal of shock resuscitation was 13 in penehyclidine hydrochloride group, 12 in anisodamine group, and 10 in control group. The incidence of compensated covert shock [gastric mucosa remained ischemic with normalized hemodynamic parameters, namely P(g-a) CO2>or=1.2 kPa] was lower in penehyclidine hydrochloride group and anisodamine group [7.7% (1/13), 16.7% (2/12)] than in control group [60.0% (6/10), P<0.05, respectively], P(g-a) CO2 in patients that attained normal hemodynamic parameters were lower in penehyclidine hydrochloride group and anisodamine group [(0.82+/-0.13) kPa and (0.91+/-0.18) kPa] than in control group [(1.22+/-0.21) kPa, P<0.01 and P<0.05]. The time for attaining the satisfactory goal of shock resuscitation was shorter in penehyclidine hydrochloride group and anisodamine group [(4.21+/-0.82) hours and (5.12+/-1.02) hours] than in control group [(6.51+/-1.22) hours, P<0.05, respectively]. However, the time to attain the satisfactory goal of shock resuscitation was shorter in penehyclidine hydrochloride group than in anisodamine group (P<0.05), but no statistically significant difference was found among other findings. CONCLUSION: Penehyclidine hydrochloride could significantly improve the microcirculation and compensated covert shock without adverse influence on heart rate, shortening of the time of shock resuscitation, and it might have the possibility of decreasing death rate in patients with septic shock. At present penehyclidine hydrochloride is one of the most promising vasoactive drugs in releasing vasoconstriction of microcirculation in patients with septic shock.