Pub Date : 2024-06-01DOI: 10.1097/jtccm-d-23-00014
C. Lima, Etienne Macedo
The use of biomarkers for managing acute kidney injury (AKI) is still not routinely used in clinical practice due to the lack of robust evidence on their impact on patient outcomes. In cirrhotic patients’ serum creatinine (sCr) limitations are more pronounced, as malnutrition, altered volume status, and muscle mass loss are more frequently encountered. This can make the diagnosis of AKI challenging, and therefore, additional markers may be necessary for a more accurate evaluation. This review will discuss the renal biomarkers of filtration and injury in patients with cirrhosis, focusing on their possible clinical application. A combined evaluation of a panel of biomarkers could provide a comprehensive assessment of kidney function and help distinguish between hepatorenal syndrome and chronic kidney disease in situations involving liver or combined liver and kidney transplantation. We will demonstrate that some biomarkers have more evidence of their utility in cirrhotic patients, such as cystatin C for filtration. In contrast, others require further studies, such as proenkephalin, which is only used in liver transplantation and appears superior to cystatin C as the inflammatory state does not influence it in cirrhotic patients. Interleukin-18 (IL-18) as a biomarker of injury in renal dysfunction in cirrhotic patients is still unclear despite extensive analysis in various scenarios, including liver diseases. On the other hand, the utility of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) is well established in renal dysfunction and evaluating other outcomes.
由于缺乏有力的证据证明生物标志物对患者预后的影响，临床实践中仍未常规使用生物标志物来管理急性肾损伤（AKI）。肝硬化患者血清肌酐（sCr）的局限性更为明显，因为营养不良、血容量状态改变和肌肉质量下降的情况更为常见。这使得 AKI 的诊断具有挑战性，因此可能需要额外的标记物来进行更准确的评估。本综述将讨论肝硬化患者肾脏滤过和损伤的生物标志物，重点关注其可能的临床应用。对一组生物标志物进行综合评估可对肾功能进行全面评估，并有助于在涉及肝移植或肝肾联合移植的情况下区分肝肾综合征和慢性肾病。我们将证明，一些生物标志物在肝硬化患者中的应用证据较多，如用于滤过的胱抑素 C。相比之下，其他生物标志物还需要进一步研究，如原脑啡肽，它只用于肝移植，似乎优于胱抑素 C，因为肝硬化患者的炎症状态不会影响它。白细胞介素-18（IL-18）作为肝硬化患者肾功能障碍损伤的生物标志物，尽管在包括肝病在内的各种情况下进行了大量分析，但仍不明确。另一方面，中性粒细胞明胶酶相关脂质钙蛋白（NGAL）和肾损伤分子-1（KIM-1）在肾功能不全和评估其他结果中的作用已得到证实。
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Pub Date : 2024-06-01DOI: 10.1097/jtccm-d-23-00009
Michelle C. Starr, Haley I Arrowood, Eliza Weston, Jennifer Chmielewski, Andrew Hopwood, Brianna M. Liberio, David T. Selewski, Danielle E. Soranno
Fluid overload, defined as a state of pathologic fluid excess or positive fluid balance, is increasingly recognized as a deleterious state in critically ill infants and children. Fluid overload is common, and mounting evidence shows that it is associated with increased mortality, organ dysfunction, and prolonged need for mechanical ventilation. Despite studies showing adverse outcomes associated with fluid overload, awareness of fluid overload remains limited, especially in small children and infants. Fluid overload as a biomarker and vital sign in the clinical setting has also not been routinely adopted despite its link with morbidity and mortality, and it remains underrecognized by providers. In this review, we first discuss the definition of fluid balance and fluid overload, then briefly review existing data on associations of fluid overload with outcomes in critically ill infants and children. We then consider existing and new data on recognition of fluid overload in critically ill children and infants before closing with the need for better awareness of fluid overload, and a discussion of future research directions and gaps in the field.
{"title":"Identification of fluid overload in critically ill children: fluid status, the missing vital sign","authors":"Michelle C. Starr, Haley I Arrowood, Eliza Weston, Jennifer Chmielewski, Andrew Hopwood, Brianna M. Liberio, David T. Selewski, Danielle E. Soranno","doi":"10.1097/jtccm-d-23-00009","DOIUrl":"https://doi.org/10.1097/jtccm-d-23-00009","url":null,"abstract":"Fluid overload, defined as a state of pathologic fluid excess or positive fluid balance, is increasingly recognized as a deleterious state in critically ill infants and children. Fluid overload is common, and mounting evidence shows that it is associated with increased mortality, organ dysfunction, and prolonged need for mechanical ventilation. Despite studies showing adverse outcomes associated with fluid overload, awareness of fluid overload remains limited, especially in small children and infants. Fluid overload as a biomarker and vital sign in the clinical setting has also not been routinely adopted despite its link with morbidity and mortality, and it remains underrecognized by providers. In this review, we first discuss the definition of fluid balance and fluid overload, then briefly review existing data on associations of fluid overload with outcomes in critically ill infants and children. We then consider existing and new data on recognition of fluid overload in critically ill children and infants before closing with the need for better awareness of fluid overload, and a discussion of future research directions and gaps in the field.","PeriodicalId":509169,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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