RESUMEN
OBJECTIVES: Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) have a high risk for developing acute kidney injury (AKI) which is associated with an increased risk of death and persistent renal failure. Early prediction of AKI is crucial in order to implement preventive strategies. The purpose of this study was to investigate the predictive performance of tissue inhibitor of metalloproteinases 2 and insulin like growth factor binding protein 7 (TIMP-2) × (IGFBP7) in critically ill patients with COVID-19-associated ARDS. DESIGN: Multicenter, prospective, observational study. SETTING: Twelve centers across Europe and United Kingdom. PATIENTS: Patients with moderate or severe COVID-19-associated ARDS were included and serial measurements of (TIMP-2) × (IGFBP7) were performed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the development of moderate or severe AKI according to the Kidney Disease: Improving Global Outcomes definition. Three hundred patients were available for the primary analysis, and 39 met the primary endpoint. At enrollment, urinary (TIMP-2) × (IGFBP7) had high predictive value for the primary endpoint with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.84-0.93). (TIMP-2) × (IGFBP7) was significantly higher in endpoint-positive patients at enrollment and at 12 hours. CONCLUSIONS: Urinary (TIMP-2) × (IGFBP7) predicts the occurrence of AKI in critically ill patients with COVID-19-associated ARDS.
Asunto(s)
Lesión Renal Aguda , COVID-19 , Humanos , Inhibidor Tisular de Metaloproteinasa-2 , Estudios Prospectivos , Enfermedad Crítica , COVID-19/complicaciones , Biomarcadores , Puntos de Control del Ciclo Celular , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Proteínas de Unión a Factor de Crecimiento Similar a la InsulinaRESUMEN
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Asunto(s)
Humanos , Masculino , Anciano , Glucemia/análisis , Neumonía/sangre , Infecciones Comunitarias Adquiridas/sangre , Cuidados Críticos/métodos , Errores Diagnósticos , Neumonía/terapia , Infecciones Comunitarias Adquiridas/terapia , Diabetes Mellitus Tipo 2/complicaciones , Insuficiencia Renal Crónica/complicaciones , Intubación , Respiración Artificial , Unidades de Cuidados IntensivosAsunto(s)
Glucemia/análisis , Capilares , Errores Diagnósticos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND AND AIM: Monitoring of complications in patients undergoing cardiac surgery may be difficult because cardiopulmonary bypass (CPB) can lead to a systemic inflammatory response syndrome because of exposure of blood to nonphysiological surfaces. The purpose of the study was to establish the baseline levels of procalcitonin (PCT) after cardiac surgery in our population in order to analyze a possible induction of the inflammatory response that might interfere with the diagnosis of infection by PCT. METHODS: Serum samples from patients undergoing coronary artery bypass grafting or valve replacement were collected at the time of admission to intensive care unit, after surgery as well as in the first and second postoperative days. Patients were followed for the development of postoperative complications. PCT levels were measured by immunoluminometric assay. RESULTS: The mean PCT values were significantly higher in the first postoperative day in all the groups except the control group. No increased PCT levels were found related neither to duration of CPB, nor to time of aortic clamping. Only patients who presented complications had significantly increased PCT values immediately after surgery (p = 0.004), in the first postoperative day (p < 0.0001), and in the second postoperative day (p < 0.0001) with respect to those who recovered uneventfully. CONCLUSIONS: A slight and transient increase in PCT levels was observed in the first postoperative day after cardiac surgery. Significant elevation of PCT was only observed when complications were present.
