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Hepatic and Renal Biochemical Markers as Predictors of Mortality Among Critically Ill Systemic Inflammatory Response Syndrome Patients

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Abstract

Systemic inflammatory response syndrome (SIRS) is a frequently encountered complication seen in intensive care unit patients and remains a common cause of mortality. Assessing prognosis of those becomes a priority and indeed we have various efficient scoring systems for the same. However they use enormous data and involve complex calculations for scoring. We intended to find a simple, inexpensive, accurate diagnostic tool of certain markers to predict mortality outcome among critically ill SIRS patients and to evaluate their efficiency in comparison to Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Eighty-seven patients were selected and general hepatic, renal and urinary investigations were done for them at 24 h of admission and were followed up for a period of 4 weeks from admission date to classify them as survivors and non-survivors. Twenty-one percent patients had succumbed to death during study period. Urine albumin–creatinine ratio, alanineaminotransferase, aspartate aminotransferase and prothrombin time/International Normalized Ratio were found to be correlating with APACHE II scores and mortality significantly. Specific individual cut-offs were found for these parameters and were combined to form combined predictors which showed good discrimination (AUC = 0.715) and good calibration (p = 0.811) with specificity of 98.6% in predicting mortality. SIRS patients falling above combined predictor’s cutoff are 54 times more likely to have an unfavorable outcome compared to the ones below. Overall predictive accuracy of first day combined predictors was such that within 24 h of ICU admission 87% of ICU SIRS admissions could be given a risk estimate for hospital death.

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References

  1. Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Med. 2000;26(1):64–74.

    Article  Google Scholar 

  2. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.

    Article  CAS  Google Scholar 

  3. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest J. 1992;101(6):1644–55.

    Article  CAS  Google Scholar 

  4. Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: a compendium. Indian J Crit Care Med. 2014;18(4):220–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.

    Article  CAS  Google Scholar 

  6. Kane SP. APACHE II Calculator [Internet]. CincCalc.com. [cited 2014 Mar 20]. http://clincalc.com/IcuMortality/APACHEII.aspx.

  7. Nelson GE, Mave V, Gupta A. Biomarkers for sepsis: a review with special attention to India. Biomed Res Int. 2014;2014:264351.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Blow O, Magliore L, Claridge JA, Butler K, Young JS. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 h improves outcome from major trauma. J Trauma. 1999;47(5):964–9.

    Article  CAS  PubMed  Google Scholar 

  9. Szabo G, Romics L Jr, Frendl G. Liver in sepsis and systemic inflammatory response syndrome. Clin Liver Dis. 2002;6(4):1045–66.

    Article  PubMed  Google Scholar 

  10. Harbrecht BG, Zenati MS, Doyle HR, McMichael J, Townsend RN, Clancy KD, et al. Hepatic dysfunction increases length of stay and risk of death after injury. J Trauma. 2002;53(3):517–23.

    Article  CAS  PubMed  Google Scholar 

  11. Brun-Buisson C, Meshaka P, Pinton P, Vallet B, EPISEPSIS Study Group. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004;30(4):580–8.

    Article  CAS  PubMed  Google Scholar 

  12. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.

    Article  CAS  PubMed  Google Scholar 

  13. Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, Kurosawa S, Stepien D, Valentine C, et al. Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev. 2013;93(3):1247–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Nesseler N, Launey Y, Aninat C, Morel F, Mallédant Y, Seguin P. Clinical review: the liver in sepsis. Crit Care. 2012;16(5):1–8.

    Article  Google Scholar 

  15. Tsiotou AG, Sakorafas GH, Anagnostopoulos G, Bramis J. Septic shock; current pathogenetic concepts from a clinical perspective. Med Sci Monit Int Med J Exp Clin Res. 2005;11(3):RA76–85.

    Google Scholar 

  16. Haraldsson B, Nystrom J, Deen WM. Properties of the glomerular barrier and mechanisms of proteinuria. Physiol Rev. 2008;88(2):451–87.

    Article  CAS  PubMed  Google Scholar 

  17. Zhang Z, Lu B, Ni H, Sheng X, Jin N. Microalbuminuria can predict the development of acute kidney injury in critically ill septic patients. J Nephrol. 2013;26(4):724–30.

    Article  CAS  PubMed  Google Scholar 

  18. Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010;38(1):261–75.

    Article  PubMed  Google Scholar 

  19. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28(5):830–8.

    Article  CAS  PubMed  Google Scholar 

  20. Moran SM, Myers BD. Course of acute renal failure studied by a model of creatinine kinetics. Kidney Int. 1985;27(6):928–37.

    Article  CAS  PubMed  Google Scholar 

  21. Thorevska N, Sabahi R, Upadya A, Manthous C, Amoateng-Adjepong Y. Microalbuminuria in critically ill medical patients: prevalence, predictors, and prognostic significance. Crit Care Med. 2003;31(4):1075–81.

    Article  CAS  PubMed  Google Scholar 

  22. Gosling P. Microalbuminuria: a marker of systemic disease. Br J Hosp Med. 1995;54(6):285–90.

    CAS  PubMed  Google Scholar 

  23. Holness L, Knippen MA, Simmons L, Lachenbruch PA. Fatalities caused by TRALI. Transfus Med Rev. 2004;18(3):184–8.

    Article  PubMed  Google Scholar 

  24. Popovsky MA. Transfusion-associated circulatory overload: the plot thickens. Transfusion (Paris). 2009;49(1):2–4.

    Article  Google Scholar 

  25. Norda R, Tynell E, Akerblom O. Cumulative risks of early fresh frozen plasma, cryoprecipitate and platelet transfusion in Europe. J Trauma. 2006;60(6):41–5.

    Article  Google Scholar 

  26. Walsh TS, Stanworth SJ, Prescott RJ, Lee RJ, Watson DM, Wyncoll D, et al. Prevalence, management, and outcomes of critically ill patients with prothrombin time prolongation in United Kingdom intensive care units. Crit Care Med. 2010;38(10):1939–46.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Biochemistry, Government Tiruvannamalai Medical College and Hospital, Tiruvannamalai, 606 604, Tamilnadu, India

    R. Srivatsan

  2. Department of Biochemistry, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Pondicherry, India

    S. Asmathulla

  3. Department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Pondicherry, India

    S. Girija

Authors
  1. R. Srivatsan
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  2. S. Asmathulla
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  3. S. Girija
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Correspondence to R. Srivatsan.

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Research Involving Human Participants

Ethical Approval for this study has been obtained and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Srivatsan, R., Asmathulla, S. & Girija, S. Hepatic and Renal Biochemical Markers as Predictors of Mortality Among Critically Ill Systemic Inflammatory Response Syndrome Patients. Ind J Clin Biochem 34, 188–194 (2019). https://doi.org/10.1007/s12291-018-0734-1

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  • DOI: https://doi.org/10.1007/s12291-018-0734-1

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