Circulating dipeptidyl peptidase-3 at admission is associated with circulatory failure, acute kidney injury and death in severely ill burn patients
| Autor: | Oliver Hartmann, Alexandre Fratani, Julien Textoris, Matthieu Legrand, Benjamin Deniau, Laure Fayolle-Pivot, Lucie Guillemet, Alexandru Cupaciu, Mourad Benyamina, Boris Farny, Alexandre Mebazaa, François Dépret, Etienne Gayat, Haikel Oueslati, Maxime Coutrot, Maïté Chaussard, Adrien Pollina, Karine Santos, Marion Jully, Juliette Amzallag |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Kidney Disease Physical Injury - Accidents and Adverse Effects Hemodynamics PRONOBURN group 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Severity of Illness Index Medical and Health Sciences Cohort Studies 03 medical and health sciences 0302 clinical medicine Patient Admission Clinical Research Risk Factors Intensive care medicine Clinical endpoint Humans Dipeptidyl peptidase-3 Prospective Studies Mortality Prospective cohort study Dipeptidyl-Peptidases and Tripeptidyl-Peptidases Aged Burn patients business.industry Research lcsh:Medical emergencies. Critical care. Intensive care. First aid Acute kidney injury 030208 emergency & critical care medicine Myocardial depressant factor Shock lcsh:RC86-88.9 Middle Aged Acute Kidney Injury medicine.disease Prognosis Angiotensin II Emergency & Critical Care Medicine Good Health and Well Being Anesthesia Female business Burns Total body surface area Biomarkers |
| Zdroj: | Critical care (London, England), vol 24, iss 1 Critical Care, Vol 24, Iss 1, Pp 1-8 (2020) Critical Care |
| Popis: | Background Dipeptidyl peptidase-3 (DPP3) is a metallopeptidase which cleaves bioactive peptides, notably angiotensin II, and is involved in inflammation regulation. DPP3 has been proposed to be a myocardial depressant factor and to be involved in circulatory failure in acute illnesses, possibly due to angiotensin II cleavage. In this study, we evaluated the association between plasmatic DPP3 level and outcome (mortality and hemodynamic failure) in severely ill burn patients. Methods In this biomarker analysis of a prospective cohort study, we included severely ill adult burn patients in two tertiary burn intensive care units. DPP3 was measured at admission (DPP3admin) and 3 days after. The primary endpoint was 90-day mortality. Secondary endpoints were hemodynamic failure and acute kidney injury (AKI). Results One hundred and eleven consecutive patients were enrolled. The median age was 48 (32.5–63) years, with a median total body surface area burned of 35% (25–53.5) and Abbreviated Burn Severity Index (ABSI) of 8 (7–11). Ninety-day mortality was 32%. The median DPP3admin was significantly higher in non-survivors versus survivors (53.3 ng/mL [IQR 28.8–103.5] versus 27.1 ng/mL [IQR 19.4–38.9]; p admin but decreased levels on day 3. Patients with circulatory failure had higher DPP3admin (39.2 ng/mL [IQR 25.9–76.1] versus 28.4 ng/mL [IQR 19.8–39.6]; p = 0.001) as well as patients with AKI (49.7 ng/mL [IQR 30.3–87.3] versus 27.6 ng/mL [IQR 19.4–41.4]; p = 0.001). DPP3admin added prognostic value on top of ABSI (added chi2 12.2, p = 0.0005), Sequential Organ Failure Assessment (SOFA) score at admission (added chi2 4.9, p = 0.0268), and plasma lactate at admission (added chi2 6.9, p = 0.0086) to predict circulatory failure within the first 48 h. Conclusions Plasma DPP3 concentration at admission was associated with an increased risk of death, circulatory failure, and AKI in severely burned patients. Whether DPP3 plasma levels could identify patients who would respond to alternative hemodynamic support strategies, such as intravenous angiotensin II, should be explored. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|