Role of biomarkers in early diagnosis of acute renal failure in the intensive care patients

Aim: Renal failure is a major cause of morbidity and mortality in critically ill patients. Because of this reason RIFLE and AKIN classifications have been established for recognition of kidneydamage in thecare of critically ill patients.The kidney damage in intensive care patients usually develops on sepsis ground. Presepsin is a new biomarker with high sensitivity and specificity used in diagnosis of sepsis. However, there are not enough studies in the literature showing the role of presepsin levels in renal failure. We aimed to investigate the role of urine and blood presepsin levels in diagnosis in critically ill patients with renal failure in this study. Materıals and Methods: This study was performed with informed consent from patients and approval of ethics committee and Çukurova University, Faculty of Medicine, Department of Anesthesiology and Reanimation. 60 adult patients aged between 18 and 75 years in the intensive care unit were included in this study. The patients were divided in two groups. The patients with renal failure while receiving intensive care unit were identified as Group I (n=30) and the patients without renal failure while receiving intensive care unit were idendified as Group II (n=30). RIFLE classification was used for the assessment of renal damage and APACHE II and SOFA scoring systems were used for assessment of intensive care disease severity. The patients who had neuropenia, HIV infection, septic shock, chronic renal failure and were receiving hemodialysis were excluded from this study. Presepsin levels in blood and urine, Hb, Htc, WBC, platelet, procalcitonin, CRP, bilirubin, Na, K, urea, creatinine and lactate levels in blood were measured during the first, second and seventh days of intensive care. Data were recorded with SPSS 16.0 program and analyzed by Çukurova University, Faculty of Medicine, Department of Biostatistics. Findings: The age and APACHE II scores of the patients in Group II were significantly higher than Group I (p < 0.05) when we analyze patients according to their demographic characteristics. There was no significant difference between SOFA scores and gender distributions betweens groups (p > 0.05). Presepsin, WBC and CRP levels in in blood were significantly higher in Group II on the seventh day. When the change of presepsin levels in blood over time was examined in both groups we observed that the values in Group I decreased and the values in Group II increased (p=0.001). Procalcitonin levels were significantly higher in Group II (p < 0.005). Procalcitonin levels of the patients decreased over time in both groups (p < 0.05). Urea and creatinine levels were significantly higher in Group II compared to Group I (p < 0.0001). While the creatinine levels of Group I decreased over time, they increased in Group II (p=0.001). GFR levels in Group II were significantly lower than Group I. There was a significant correlation between blood and urinary presepsin levels (p < 0.0001, r = 0.65). Negative correlation was found between blood and urinary presepsin levels and procalcitonin levels. Results: Presepsin and procalcitonin levels were found significantly higher than those in patients with acute renal failure in intensive care unit. However, when presepsin levels in urine were considered, there was no difference between patients with or without acute renal failure. Presepsin levels in blood were associated with the disease severity in the patients with acute renal failure.