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Olle Melander

Principal investigator

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Proenkephalin a 119-159 (penKid) - a novel biomarker for acute kidney injury in sepsis : an observational study

Author

  • Mari Rosenqvist
  • Kevin Bronton
  • Oliver Hartmann
  • Andreas Bergmann
  • Joachim Struck
  • Olle Melander

Summary, in English

Background: Sepsis is a leading cause of death worldwide and a major challenge for physicians to predict and manage. Proenkephalin A 119-159 (penKid) is a reliable surrogate marker for the more unstable endogenous opioid peptide enkephalin, which has previously been shown to predict both acute and chronic kidney disease. The aim of this prospective observational study was to assess penKid as a predictor of acute kidney injury (AKI), multi-organ failure and mortality in sepsis among unselected sepsis patients presenting to the emergency department (ED).

Method: We enrolled 644 patients consecutively during office-hours (6 AM-6 PM) between December 1, 2013 and February 1, 2015. Fifty-six patients were excluded due to incomplete data. We measured penKid in 588 adult patients (patients under 18 years of age were excluded) with sepsis (≥2SIRS criteria + suspected infection) upon admission to the ED at Skåne University Hospital, Malmö, Sweden. Logistic regression analysis was used to relate levels of penKid at presentation to AKI, multi-organ failure, 28-day mortality and progression of renal SOFA subscore. Odds ratios are presented as the number of standard deviations from the mean of log-transformed penKid.

Results: In age and sex adjusted models, penKid predicted AKI within 48 h and 7 days, but these associations were attenuated after additional adjustment for estimated creatinine-based glomerular filtration rate (eGFR). In models adjusted for age, sex and eGFR, penKid significantly predicted progression from rSOFA = 0 and ≤ 1 to higher rSOFA scores as well as multi-organ failure and mortality. In contrast, eGFR did not predict 28-day mortality.

Conclusion: PenKid is an effective predictor of renal injury, severe multi-organ failure and mortality in unselected sepsis patients presenting to the emergency department.

Department/s

  • EXODIAB: Excellence in Diabetes Research in Sweden
  • Cardiovascular Research - Hypertension
  • EpiHealth: Epidemiology for Health

Publishing year

2019-11-28

Language

English

Publication/Series

BMC Emergency Medicine

Volume

19

Document type

Journal article

Publisher

BioMed Central (BMC)

Topic

  • Urology and Nephrology

Keywords

  • Acute kidney injury
  • AKI
  • Emergency department
  • penKid
  • Pro-enkephalin
  • Sepsis

Status

Published

Research group

  • Cardiovascular Research - Hypertension

ISBN/ISSN/Other

  • ISSN: 1471-227X