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

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-01-01 Epub Date: 2023-11-02 DOI:10.1159/000534107

Sian E Piret, Sobia Khan, Fabliha Fairuz, Samaneh Gholami, Merin Davis, Chang Kyung Kim, Melissa Espinoza, Debra Foster, John A Kellum, Sahar Ahmad, Andreas P Kalogeropoulos, Sandeep K Mallipattu

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Abstract

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 (SaO2) to fraction of inspired oxygen (FiO2) (SaO2/FiO2) 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.

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危重病人的内毒素血症与肾功能和住院时间相关。

简介：内毒素是败血症的关键驱动因素，败血症经常导致急性肾损伤（AKI）。然而，内毒素也可能在非菌血症危重患者中发现，可能来自肠道移位。临床前模型显示，内毒素可直接损害肾脏，在新冠肺炎患者中，内毒素血症与AKI相关。我们试图在广泛的危重患者群体中确定内毒素血症与肾脏和医院结果之间的相关性。方法：在这项单中心、连续的前瞻性研究中，124名以白人为主的成年患者在入住石溪大学医院重症监护室（ICU）后48小时内被招募。收集人口统计学、生命体征、实验室数据和结果。使用内毒素活性测定法（EAA）在第1、4和8天测量循环内毒素。EAA与结果的相关性用EAA检验：（1）分类为<；0.6，≥0.6，以及无反应（NRs）；以及（2）用作连续变量。结果：与EAA<；0.6.EAA水平与第1天的血清肌酐（sCr）水平呈正相关。与EAA在≥0.6时开始并随后下降的患者相比，EAA水平保持≥0.6的患者sCr下降较慢。与1期AKI和EAA<；0.6.EAA≥0.6和NR患者的住院时间更长，ICU出院延迟，而EAA<；结论：EAA水平高与肾功能和预后较差相关。EAA水平下降的患者以及AKI I期和第1天EAA<；与EAA≥0.6的患者相比，0.6的患者恢复得更快，这表明清除循环内毒素可能对危重患者有益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.