RESUMO
BACKGROUND: Acute kidney disease (AKD) describes acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury (AKI) initiating event. This study investigated the predictive ability of AKI biomarkers in predicting AKD in coronary care unit (CCU) patients. METHODS: A total of 269 (mean age: 64 years; 202 (75%) men and 67 (25%) women) patients admitted to the CCU of a tertiary care teaching hospital from November 2009 to September 2014 were enrolled. Information considered necessary to evaluate 31 demographic, clinical and laboratory variables (including AKI biomarkers) was prospectively recorded on the first day of CCU admission for post hoc analysis as predictors of AKD. Blood and urinary samples of the enrolled patients were tested for neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and interleukin-18 (IL-18). RESULTS: The overall hospital mortality rate was 4.8%. Of the 269 patients, 128 (47.6%) had AKD. Multivariate logistic regression analysis revealed that age, hemoglobin, ejection fraction and serum IL-18 were independent predictors of AKD. Cumulative survival rates at 5 years of follow-up after hospital discharge differed significantly (p < 0.001) between subgroups of patients diagnosed with AKD (stage 0A, 0C, 1, 2 and 3). The overall 5-year survival rate was 81.8% (220/269). Multivariate Cox proportional hazard analysis revealed that urine NGAL, body weight and hemoglobin level were independent risk factors for 5-year mortality. CONCLUSIONS: This investigation confirmed that AKI biomarkers can predict AKD in CCU patients. Age, hemoglobin, ejection fraction and serum IL-18 were independently associated with developing AKD in the CCU patients, and urine NGAL, body weight and hemoglobin level could predict 5-year survival in these patients.
Assuntos
Injúria Renal Aguda/sangue , Injúria Renal Aguda/urina , Insuficiência Renal/sangue , Insuficiência Renal/urina , Doença Aguda , Injúria Renal Aguda/complicações , Injúria Renal Aguda/mortalidade , Fatores Etários , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Peso Corporal , Clofibrato/sangue , Clofibrato/urina , Unidades de Cuidados Coronarianos , Cistatina C/sangue , Cistatina C/urina , Combinação de Medicamentos , Feminino , Seguimentos , Hemoglobinas/metabolismo , Mortalidade Hospitalar , Humanos , Interleucina-18/sangue , Interleucina-18/urina , Masculino , Pessoa de Meia-Idade , Fosfatidilcolinas/sangue , Fosfatidilcolinas/urina , Modelos de Riscos Proporcionais , Insuficiência Renal/etiologia , Insuficiência Renal/mortalidade , Volume Sistólico , Taxa de SobrevidaRESUMO
A rapid gas chromatographic method is described for the determination of chlorophenoxyisobutyric acid (the active metabolite of clofibrate) in plasma and urine. The assay involves an extraction into toluene and back-extraction of the chlorophenoxyisobutyric acid and the internal standard (2-naphthoic acid) into the methylating reagent (trimethylanilinium hydroxide). Concentrations of 1 mug/ml in plasma and urine can easily be measured; the precision of the method is 3.3 +/- 0.7% for plasma and 2.7 +/- 0.4% for urine. There is no interference from endogenous compounds or from drugs commonly prescribed together with clofibrate.
Assuntos
Cromatografia Gasosa/métodos , Clofibrato/análogos & derivados , Clofibrato/sangue , Clofibrato/urina , Temperatura Alta , Humanos , Fatores de TempoRESUMO
A specific and sensitive method is described for the detection of clofibrate in biological fluids. The drug is separated from associated fatty acids by thin-layer chromatography and the methyl ester is quantified by gas-liquid chromatography. Recovery is excellent, and any small losses are corrected with an internal recovery standard. Although more time-consuming than other available techniques, the method offers advantages for accurate studies of clofibrate metabolism.