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2017 ; 37
(5
): 388-397
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Proenkephalin, Neutrophil Gelatinase-Associated Lipocalin, and Estimated
Glomerular Filtration Rates in Patients With Sepsis
#MMPMID28643487
Kim H
; Hur M
; Lee S
; Marino R
; Magrini L
; Cardelli P
; Struck J
; Bergmann A
; Hartmann O
; Di Somma S
Ann Lab Med
2017[Sep]; 37
(5
): 388-397
PMID28643487
show ga
BACKGROUND: Proenkephalin (PENK) has been suggested as a novel biomarker for
kidney function. We investigated the diagnostic and prognostic utility of plasma
PENK in comparison with neutrophil gelatinase-associated lipocalin (NGAL) and
estimated glomerular filtration rates (eGFR) in septic patients. METHODS: A total
of 167 septic patients were enrolled: 99 with sepsis, 37 with septic shock, and
31 with suspected sepsis. PENK and NGAL concentrations were measured and GFR was
estimated by using the isotope dilution mass spectrometry traceable-Modification
of Diet in Renal Disease (MDRD) Study and three Chronic Kidney Disease
Epidemiology Collaboration (CKD-EPI) equations: CKD-EPI(Cr), CDK-EPI(CysC), and
CKD-EPI(Cr-CysC). The PENK, NGAL, and eGFR results were compared according to
sepsis severity, presence or absence of acute kidney injury (AKI), and clinical
outcomes. RESULTS: The PENK, NGAL, and eGFR results were significantly associated
with sepsis severity and differed significantly between patients with and without
AKI only in the sepsis group (all P<0.05). PENK was superior to NGAL in
predicting AKI (P=0.022) and renal replacement therapy (RRT) (P=0.0085).
Regardless of the variable GFR category by the different eGFR equations, PENK
showed constant and significant associations with all eGFR equations. Unlike
NGAL, PENK was not influenced by inflammation and predicted the 30-day mortality.
CONCLUSIONS: PENK is a highly sensitive and objective biomarker of AKI and RRT
and is useful for prognosis prediction in septic patients. With its diagnostic
robustness and predictive power for survival, PENK constitutes a promising
biomarker in critical care settings including sepsis.