engleski

ProANP (1-98), but not cystatin C has predictive value for occurance of acute renal insufficiency in critically ill septic patients

Acute renal insufficiency has high mortality rate among critically ill septic patients. Extensive investigations have been undertaken to elucidate mechanism of the complication and to find predictive factors for its occurence. We determined biochemical markers, proANP (EIA, fmol/ml) and cystatin C (immunoturbidimetric, mg/L), in septic patients on admittance to the ICU an correlated it with the development of acute renal insufficiency (RI). ProANP is a prohormone of atrial natriuretic peptid released from right atria and has diuretic and natriuretic properties. Cystatin C is a new marker for noninvasive estimation of glomelurular filtration rate and for early renal impairament. 29 critically ill septic patients were included in the study. ProANP, cystatin C and standard biochemical variables were determined on admittance to the ICU. EDTA blood samles from periferal vein were collected. General condition of patients was determined using clinical scoring systems APACHE II and MODS . Haemodynamic variables obtained by measurements using pulmonary artery catheter and effects of inotropeic drugs were analysed, as well. Acute renal insufficiency was determined according to the standard definition as creatinin value of 267 ěmol/ or diuresis < 30 mL/h in patient with no history of cronic renal impairment. Statistical analysis between groups with and without renal insufficiency was done using Mann - Whitney U test. Corrrelation between proANP, cystatin C, biochemical and clinical variables were analysed using linear regression. Our resultes showed that proANP is significantlly higher in the group with renal insufficiency, (medians with RI=1971, without RI=7220 ; P<0. 005), and higher in nonsurvivors (median nonsurvivors =4786, survivors =1943 ; P<0.029). The incidence of acute renal insufficiency is correlated with poor general condition of patients assesed using MODS , P < 0.005 and APACHE II P < 0.005 scoring systems. Cystatin C is not correlated with the occurrence of renal insuffiency in this subgroup of critically ill septic patients. Higher plasma proANP level on admittance to the ICU have predictive value for occurence of acute renal insufficiency in this subgroup of critically ill septic patients. Cystatin C is not a clinically uesful marker of early renal impairment in the investigated patients.

proANP; acute renal insufficiency; septic patients

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