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

Autor:	Piret SE; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Khan S; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Fairuz F; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Gholami S; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Davis M; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Kim CK; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Espinoza M; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Foster D; Spectral Medical Inc., Toronto, Ontario, Canada., Kellum JA; Spectral Medical Inc., Toronto, Ontario, Canada., Ahmad S; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Kalogeropoulos AP; Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York, USA., Mallipattu SK; Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York, USA.; Renal Section, Northport VA Medical Center, Northport, New York, USA.
Jazyk:	angličtina
Zdroj:	Blood purification [Blood Purif] 2024; Vol. 53 (1), pp. 30-39. Date of Electronic Publication: 2023 Nov 02.
DOI:	10.1159/000534107
Abstrakt:	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. (© 2023 S. Karger AG, Basel.)
Databáze:	MEDLINE
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