Impact factor 0.175

Signa Vitae

Journal of Intensive Care and Emergency Medicine

Tag: biomarkers

A prognostic value of early urinary biomarkers NGAL and IL-18 in critically ill children: a 10-year literature review

Abstract

Introduction. Acute kidney injury (AKI) is a life-threatening syndrome caused by a sudden and rapidly progressing impairment of renal function. It is a common and complicated clinical entity among hospitalized children, occurring in 2%-4.5% of children treated in a pediatric intensive care unit. Mortality among such patients remains high (from 8% to 89%) despite improving patient care and technical possibilities. The stage of renal damage is a reversible process, and its timely detection would prevent the progression of renal damage and thus reduce pediatric mortality rates. Therefore, modern medicine necessitates the identification of novel AKI biomarkers that would correlate with renal cell damage and could be detected earlier than a rise in serum creatinine (sCr). Neutrophil gelatinase-associated lipocalin (NGAL) and interleukin 18 (IL-18) are one of such early markers of AKI.

Aim. To carry out a literature review of studies on changes in NGAL and IL-18 levels in the urine of critically ill patients and to determine a prognostic value of these biomarkers in the detection of renal injury and impact on disease outcomes.

Material and methods. This literature review includes the publications of biomedical studies assessing early biomarkers of AKI in urine (uNGAL or uIL-18) of critically ill children, published in English during the 10-year period. Search for publication was performed in the PubMed database.

Results. Analysis included 10 studies that investigated early biomarkers of AKI (NGAL or IL-18) in urine of critically ill children and compared them with sCr. Among the biomedical studies analyzed in our literature review, 9 measured the NGAL level in urine or both in urine and serum, while 2measured IL-18 in urine. It was determined that uNGAL and uIL-18 were good early diagnostic biomarkers of AKI, which increased 48 h earlier than Cr in serum (P<0.005). The meta-analysis carried out by Haase et al. showed that uNGAL predicted the development of AKI better in critically ill children than in adults (OR, 25.4; ROC, 0.930 vs. OR, 10.6; ROC, 0.782). Three studies reported that the uNGAL level in study populations with AKI directly depended on disease severity and AKI degree (P<0.005). Four studies found that uNGAL and one study that uIL-18 are good predictive factors of mortality (P<0.005).

Conclusions. uNGAL and uIL-18 are early predictive biomarkers of AKI in critically ill children. uNGAL and uIL-18 level correlated well with disease severity and are independent predictive biomarkers of mortality.

Key words: acute kidney injury, critically ill children, biomarkers, uNGAL, uIL-18.

Read More

Can first trimester placental biomarkers copeptin and PP13 predict preeclampsia in advanced age nulliparous women?

Abstract

Preeclampsia (PE) affects approximately 3% of all pregnancies and it is still a major cause of adverse perinatal outcome. PE is a multisystem pregnancy related disorder of unknown aetiology with a progressive course and with no established therapy. In recent times excessive research was conducted on early screening for PE with an aim to reduce the prevalence of the disease with early medical treatment starting from the first trimester of pregnancy in the high-risk group. The aim of this study is to detect if the first trimester serum copeptin and PP13 can predict preeclampsia in advanced age nulliparous women. These are the preliminary results of an ongoing prospective study that will include 400 pregnant women undergoing first trimester aneuploidy screening at the Department for Obstetrics and Gynaecology, University Hospital Centre Zagreb. Maternal risk factors used as inclusion criteria in this study were: nulliparity and age >35. Participants were asked to complete a short questionnaire regarding personal and medical information. Blood samples were collected and maternal serum PP13 and copeptin levels were measured. Following the inclusion criteria, we analysed the records of 40 women who gave birth to this date. Three patients (7.5%) developed preeclampsia and eight (20%) had gestational hypertension (GH). All PE patients had elevated plasma copeptin. Our preliminary data suggests that early screening for PE at 11-13 weeks of gestation using biomarkers copeptin and PP-13, in combination with maternal risk factors, is by far the most promising method for early detection of PE in advanced age nulliparous women.

Key words: preeclampsia, biomarkers, copeptin, high-risk pregnant women

Read More

Biomarkers of sepsis in neonates and children

Abstract

Sepsis, and related complications, is still a common cause of death in hospitalized patients worldwide, especially in critically ill neonates and children. Sepsis is also responsible for significant morbidity, and financial burden. It is very important to recognize sepsis early, since delayed diagnosis is associated with worse outcome. The early detection of sepsis remains a great challenge for clinicians because the use of blood cultures, the gold standard for diagnosis of bacteremia, is fraught with difficulties. The role of different immune and metabolic biomarkers is to improve the diagnosis, treatment and prognosis of sepsis. White blood cell count, C-reactive protein and procalcitonin are currently the most widely used biomarkers, but they have limited abilities to distinguish sepsis from other inflammatory conditions or to predict outcome. In this review, these biomarkers will be discussed along with novel diagnostic, prognostic and treatment response biomarkers, including interleukins -6, -8, -18, tumor necrosis factor – alpha, CD11b, CD64 and CD15s. The future of sepsis biomarkers lies in extensive validation studies of all novel biomarkers and their combinations as early predictors of sepsis. Also, research to identify novel sepsis biomarkers and develop specific therapeutic strategies based on biomarker information has to be continued.

Key words: infant, child, biomarkers, CD15s antigen, C-reactive protein, procalcitonin

Read More

Testing of potential biomarkers of cerebral ischemia and vasospasm in patients with cerebral aneurysm surgery

Abstract

Biomarkers for the prediction of vasospasm and delayed cerebral ischemia in patients with a ruptured cerebral aneurysm could be helpful.

In this prospective clinical study, endothelin-1, lactate, pCO2, and pO2 were measured in arterial and internal jugular vein blood before, during and after surgical treatment of a cerebral aneurysm, and were tested as potential predictors of neurologic outcome in patients.

Forty-one patients were enrolled in the study, 23 of them were operated on after aneurismal rupture with development of subarachnoid hemorrhage (SAH) and 18 patients were operated on for a nonruptured aneurysm.

All of the involved patients survived. There was no difference in neurologic outcome between those operated on with a ruptured or nonruptured aneurysm.

Endothelin-1 and lactate concentrations as well as pO2 and pCO2 from arterial and venous blood samples and their venoarterial difference did not differ between groups with and without an aneurismal rupture. Venoarterial difference of endothelin-1 concentrations on the day after surgery significantly differed between the groups with favorable and nonfavorable neurologic outcome. Other variables did not show a statistically significant difference.

Significant correlation was found between endothelin-1 and lactate concentrations, suggesting involvement of the same pathophysiological process.

Another interesting finding was lower arterial and venous pCO2 in patients with lower initial Glasgow Coma Scale (GCS) score and higher Hunt Hess score in the phase after extubation.

We can conclude that the measured biochemical parameters did not show sufficient predictive power to be useful for prediction of cerebral vasospasm and neurologic outcome in everyday clinical practice. However, some correlations that do exist between them suggest involvement of the same pathophysiological process.

Key words: cerebral aneurysm, neurosurgery, endothelin-1, biomarkers, delayed cerebral ischemia

Read More

© 2019. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.