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Microalbuminuria: A novel biomarker of sepsis

CONTEXT: Diffused endothelial dysfunction in sepsis leads to an increase in systemic capillary permeability, the renal component manifesting as microalbuminuria. The degree of microalbuminuria correlates with the severity of the acute insult, the quantification of which may serve to predict sepsis a...

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Autores principales: Basu, Surupa, Bhattacharya, Mahuya, Chatterjee, Tapan K., Chaudhuri, Subimal, Todi, Subhash K., Majumdar, Arghya
Formato: Texto
Lenguaje:English
Publicado: Medknow Publications 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888326/
https://www.ncbi.nlm.nih.gov/pubmed/20606905
http://dx.doi.org/10.4103/0972-5229.63034
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author Basu, Surupa
Bhattacharya, Mahuya
Chatterjee, Tapan K.
Chaudhuri, Subimal
Todi, Subhash K.
Majumdar, Arghya
author_facet Basu, Surupa
Bhattacharya, Mahuya
Chatterjee, Tapan K.
Chaudhuri, Subimal
Todi, Subhash K.
Majumdar, Arghya
author_sort Basu, Surupa
collection PubMed
description CONTEXT: Diffused endothelial dysfunction in sepsis leads to an increase in systemic capillary permeability, the renal component manifesting as microalbuminuria. The degree of microalbuminuria correlates with the severity of the acute insult, the quantification of which may serve to predict sepsis and mortality in critically ill patients. AIMS: To evaluate whether the degree of microalbuminuria could differentiate patients with sepsis from those without and predict mortality in critically ill patients. SETTINGS AND DESIGN: Prospective, non-interventional study in a 20-bed Intensive Care Unit (ICU) of a tertiary care hospital. METHODS AND MATERIALS: After exclusions, between Jan-May 2007, 94 consecutive adult patients were found eligible. Albumin-creatinine ratio (ACR, mg/g) was measured in urine samples collected on ICU admission (ACR1) and at 24 hours (ACR2). RESULTS: Patients were classified into two groups: those with sepsis, severe sepsis and septic shock (n = 30) and those without sepsis [patients without systemic inflammatory response syndrome (SIRS) and with SIRS due to noninfectious causes] (n = 64). In the sepsis group, median ACR1 [206.5 (IQR129.7-506.1)] was significantly higher compared to the non sepsis group [76.4 (IQR29-167.1)] (P = 0.0016, Mann Whitney). The receiver operating characteristics (ROC) curve analysis showed that at a cut off value 124 mg/g, ACR1 may be able to discriminate between patients with and without sepsis with a sensitivity of 80%, specificity of 64.1%, positive predictive value (PPV) of 51.1% and negative predictive value (NPV) of 87.3%. The median ACR2 [154 (IQR114.4-395.3)] was significantly higher (P = 0.004) in nonsurvivors (n = 13) as compared to survivors [50.8 (IQR 21.6-144.7)]. The ROC curve analysis revealed that ACR2 at a cut-off of 99.6 mg/g could predict ICU mortality with sensitivity of 85%, specificity of 68% with a NPV of 97% and PPV of 30%. CONCLUSION: Absence of significant microalbuminuria on ICU admission is unlikely to be associated with sepsis. At 24 hours, absence of elevated levels of microalbuminuria is strongly predictive of ICU survival, equivalent to the time-tested APACHE II scores.
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spelling pubmed-28883262010-07-02 Microalbuminuria: A novel biomarker of sepsis Basu, Surupa Bhattacharya, Mahuya Chatterjee, Tapan K. Chaudhuri, Subimal Todi, Subhash K. Majumdar, Arghya Indian J Crit Care Med Research Article CONTEXT: Diffused endothelial dysfunction in sepsis leads to an increase in systemic capillary permeability, the renal component manifesting as microalbuminuria. The degree of microalbuminuria correlates with the severity of the acute insult, the quantification of which may serve to predict sepsis and mortality in critically ill patients. AIMS: To evaluate whether the degree of microalbuminuria could differentiate patients with sepsis from those without and predict mortality in critically ill patients. SETTINGS AND DESIGN: Prospective, non-interventional study in a 20-bed Intensive Care Unit (ICU) of a tertiary care hospital. METHODS AND MATERIALS: After exclusions, between Jan-May 2007, 94 consecutive adult patients were found eligible. Albumin-creatinine ratio (ACR, mg/g) was measured in urine samples collected on ICU admission (ACR1) and at 24 hours (ACR2). RESULTS: Patients were classified into two groups: those with sepsis, severe sepsis and septic shock (n = 30) and those without sepsis [patients without systemic inflammatory response syndrome (SIRS) and with SIRS due to noninfectious causes] (n = 64). In the sepsis group, median ACR1 [206.5 (IQR129.7-506.1)] was significantly higher compared to the non sepsis group [76.4 (IQR29-167.1)] (P = 0.0016, Mann Whitney). The receiver operating characteristics (ROC) curve analysis showed that at a cut off value 124 mg/g, ACR1 may be able to discriminate between patients with and without sepsis with a sensitivity of 80%, specificity of 64.1%, positive predictive value (PPV) of 51.1% and negative predictive value (NPV) of 87.3%. The median ACR2 [154 (IQR114.4-395.3)] was significantly higher (P = 0.004) in nonsurvivors (n = 13) as compared to survivors [50.8 (IQR 21.6-144.7)]. The ROC curve analysis revealed that ACR2 at a cut-off of 99.6 mg/g could predict ICU mortality with sensitivity of 85%, specificity of 68% with a NPV of 97% and PPV of 30%. CONCLUSION: Absence of significant microalbuminuria on ICU admission is unlikely to be associated with sepsis. At 24 hours, absence of elevated levels of microalbuminuria is strongly predictive of ICU survival, equivalent to the time-tested APACHE II scores. Medknow Publications 2010 /pmc/articles/PMC2888326/ /pubmed/20606905 http://dx.doi.org/10.4103/0972-5229.63034 Text en © Indian Journal of Critical Care Medicine http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Basu, Surupa
Bhattacharya, Mahuya
Chatterjee, Tapan K.
Chaudhuri, Subimal
Todi, Subhash K.
Majumdar, Arghya
Microalbuminuria: A novel biomarker of sepsis
title Microalbuminuria: A novel biomarker of sepsis
title_full Microalbuminuria: A novel biomarker of sepsis
title_fullStr Microalbuminuria: A novel biomarker of sepsis
title_full_unstemmed Microalbuminuria: A novel biomarker of sepsis
title_short Microalbuminuria: A novel biomarker of sepsis
title_sort microalbuminuria: a novel biomarker of sepsis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888326/
https://www.ncbi.nlm.nih.gov/pubmed/20606905
http://dx.doi.org/10.4103/0972-5229.63034
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