Endotoxemia Correlates with Kidney Function and Length of Stay in Critically Ill Patients

被引:0
作者
Piret, Sian E. [1 ]
Khan, Sobia [1 ]
Fairuz, Fabliha [1 ]
Gholami, Samaneh [1 ]
Davis, Merin [1 ]
Kim, Chang Kyung [1 ]
Espinoza, Melissa [1 ]
Foster, Debra [2 ]
Kellum, John A. [2 ]
Ahmad, Sahar [3 ]
Kalogeropoulos, Andreas P. [4 ]
Mallipattu, Sandeep K. [1 ,5 ]
机构
[1] SUNY Stony Brook, Dept Med, Div Nephrol & Hypertens, Stony Brook, NY 11794 USA
[2] Spectral Med Inc, Toronto, ON, Canada
[3] SUNY Stony Brook, Div Pulm Crit Care & Sleep Med, Dept Med, Stony Brook, NY USA
[4] SUNY Stony Brook, Dept Med, Div Cardiol, Stony Brook, NY USA
[5] Northport VA Med Ctr, Renal Sect, Northport, NY 11768 USA
关键词
Acute kidney injury; Intensive care unit; Endotoxin; ACUTE-RENAL-FAILURE; POLYMYXIN-B HEMOPERFUSION; LONG-TERM SURVIVAL; SEPTIC SHOCK; CRITICAL ILLNESS; INJURY; SEPSIS; EPIDEMIOLOGY;
D O I
10.1159/000534107
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Endotoxin is a key driver of sepsis, which frequently causes acute kidney injury (AKI). However, endotoxins may also be found in non-bacteremic critically ill patients, likely from intestinal translocation. Preclinical models show that endotoxins can directly injure the kidneys, and in COVID-19 patients, endotoxemia correlated with AKI. We sought to determine correlations between endotoxemia and kidney and hospital outcomes in a broad group of critically ill patients. Methods: In this single-center, serial prospective study, 124 predominantly Caucasian adult patients were recruited within 48 h of admission to Stony Brook University Hospital Intensive Care Unit (ICU). Demographics, vital signs, laboratory data, and outcomes were collected. Circulating endotoxin was measured on days 1, 4, and 8 using the endotoxin activity assay (EAA). The association of EAA with outcomes was examined with EAA: (1) categorized as <0.6, >= 0.6, and nonresponders (NRs); and (2) used as a continuous variable. Results: Patients with EAA >= 0.6 had a higher prevalence of proteinuria, and lower arterial oxygen saturation (SaO(2)) to fraction of inspired oxygen (FiO(2)) (SaO(2)/FiO(2)) ratio versus patients with EAA <0.6. EAA levels positively correlated with serum creatinine (sCr) levels on day 1. Patients whose EAA level stayed >= 0.6 had a slower decline in sCr compared to those whose EAA started at >= 0.6 and subsequently declined. Patients with AKI stage 1 and EAA >= 0.6 on day 1 showed slower decline in sCr compared to patients with stage 1 AKI and EAA <0.6. EAA >= 0.6 and NR patients had longer hospital stay and delayed ICU discharge versus EAA <0.6. Conclusions: High EAA levels correlated with worse kidney function and outcomes. Patients whose EAA levels fell, and those with AKI stage I and day 1 EAA <0.6 recovered more quickly compared to those with EAA >= 0.6, suggesting that removal of circulating endotoxins may be beneficial in critically ill patients.
引用
收藏
页码:30 / 39
页数:10
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