The use of plasma and urine neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C in early diagnosis of septic acute kidney injury in critically ill patients.

AIM: To assess and compare the roles of plasma and urine concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis of septic acute kidney injury (AKI) in adult critically ill patients. METHODS: Patients were divided into three groups as sepsis-non AKI, sepsis-AKI and non sepsis-non AKI. Plasma samples for NGAL and Cystatin C were determined on admission and on alternate days and urinary samples were collected for every day until ICU discharge. RESULTS: One hundred fifty one patients were studied; 66 in sepsis-non AKI, 63 in sepsis-AKI, 22 in non-sepsis-non-AKI groups. Although plasma NGAL performed less well (AUC 0.44), urinary NGAL showed significant discrimination for AKI diagnosis (AUC 0.80) with a threshold value of 29.5 ng/ml (88% sensitivity, 73% specificity). Both plasma and urine Cystatin C worked well for the diagnosis of AKI (AUC 0.82 and 0.86, thresholds 1.5 and 0.106 mg/L respectively). CONCLUSION: Plasma and urinary Cystatin C and urinary NGAL are useful markers in predicting AKI in septic critically ill patients. Plasma NGAL raises in patients with sepsis in the absence of AKI and should be used with caution as a marker of AKI in septic ICU patients.

Factors associated with noninvasive ventilation response in the first day of therapy in patients with hypercapnic respiratory failure.

BACKGROUND AND AIM: Noninvasive ventilation (NIV) decreases mechanical ventilation indication in the early period of acute hypercapnic respiratory failure (AHcRF) and factors for success have been studied well. But, less is known about the factors influencing the NIV response in the subacute period. This study was aimed to determine the factors influencing the reduction of PaCO(2) levels within first 24 hours of therapy. METHODS: NIV response was defined as reduction of PaCO(2) level below 50 mmHg within first 24 hours. Patients with AHcRF, treated with NIV, were divided into 2 groups according to this criterion; group 1 as the nonresponsive, group 2 as the responsive. The differences in NIV methods and characteristics of the two groups were evaluated and compared in this retrospective study. RESULTS: A total of 100 patients were included in the study; 66 of them in group 1 and 34 in group 2. No significant differences were identified between the length of NIV application and intensive care unit (ICU) stay, intubation and mortality rates, across the groups. Ninety-one percent of the patients in group 2 had received all night long NIV therapy; this was just 74% in group 1 (P=0.036). Results of multivariate analysis showed that while nocturnal application was significantly associated with better response, prior home ventilation and requirement of higher pressure support (PS) levels significantly and independently associated with poorer response to NIV therapy. CONCLUSION: In patients with AHcRF, all night long use of NIV may accelerate healing by improving PaCO(2) reduction within the first 24 hours. A rapid response in PaCO(2) levels should not be expected in patients requiring higher PS levels and using prior home ventilation.

Comparison of the value of initial and serial endotracheal aspirate surveillance cultures in predicting the causative pathogen of ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit (ICU) and its outcome is affected by the adequacy and timing of initial antibiotic therapy. Recent studies have suggested that surveillance cultures of the lower airways may provide microbiological guidance for initial antibiotic prescription and increase the use of appropriate antibiotic therapy. This study aimed to compare the predictive value of initial and serial surveillance cultures of endotracheal aspirates in predicting the causative pathogen of VAP in patients receiving antibiotic therapy. This was an observational prospective cohort study. Ninety-two patients ventilated for at least 4 days were recruited into the study. Initial (IS-ETA) and serial (SS-ETA) endotracheal aspirate surveillance cultures were obtained on the day of intubation and every second day, respectively. The sensitivity, specificity, and positive and negative predictive values for the causative pathogens of VAP were calculated for each surveillance culture. Ninety-two initial and 252 serial surveillance cultures were obtained during the study period. The sensitivity of IS-ETA culture was 12% and of SS-ETA culture was 44%. The sensitivity of SS-ETA in late-onset VAP was 51%. The value of SS-ETA surveillance cultures was better than IS-ETA surveillance in predicting the causative pathogen of VAP, particularly in late-onset pneumonia.