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Sci Rep. 2018 Aug 10;8(1):11968. doi: 10.1038/s41598-018-30361-5.

Hypoalbuminemia as a predictor of acute kidney injury during colistin treatment.

Author information

1
Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia and Department of Health Science (DISSAL), University of Genoa, Genoa, Italy. daniele.roberto.giacobbe@gmail.com.
2
Department of Sciences, Section Biomedical Sciences and Technology, Roma Tre University, Rome, Italy.
3
Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
4
Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
5
Città di Lecce Hospital - GVM Care and Research, Lecce, Italy.
6
Microbiology Unit, University of Genoa (DISC) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy.
7
Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia and Department of Health Science (DISSAL), University of Genoa, Genoa, Italy.
8
Department of Health Science (DISSAL), University of Genoa, Genoa, Italy.
9
Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy.
10
Clinical Microbiology and Virology Unit, A. Manzoni Hospital, Lecco, Italy.
11
Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
12
Maria Cecilia Hospital - GVM Care & Research, Cotignola, Italy.
13
University of Milan and Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Abstract

This study aimed to assess the predictors of acute kidney injury (AKI) during colistin therapy in a cohort of patients with bloodstream infections (BSI) due to colistin-susceptible Gram-negative bacteria, focusing on the role of serum albumin levels. The study consisted of two parts: (1) a multicentre retrospective clinical study to assess the predictors of AKI during colistin therapy, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria; and (2) bioinformatic and biochemical characterization of the possible interaction between human serum albumin and colistin. Among the 170 patients included in the study, 71 (42%), 35 (21%), and 11 (6%) developed KDIGO stage 1 (K1-AKI), KDIGO stage 2 (K2-AKI), and KDIGO stage 3 (K3-AKI), respectively. In multivariable analyses, serum albumin <2.5 g/dL was independently associated with K1-AKI (subdistribution hazard ratio [sHR] 1.85, 95% confidence interval [CI] 1.17-2.93, p = 0.009) and K2-AKI (sHR 2.37, 95% CI 1.15-4.87, p = 0.019). Bioinformatic and biochemical analyses provided additional information nurturing the discussion on how hypoalbuminemia favors development of AKI during colistin therapy. In conclusion, severe hypoalbuminemia independently predicted AKI during colistin therapy in a large cohort of patients with BSI due to colistin-susceptible Gram-negative bacteria. Further study is needed to clarify the underlying causal pathways.

PMID:
30097635
PMCID:
PMC6086859
DOI:
10.1038/s41598-018-30361-5
[Indexed for MEDLINE]
Free PMC Article

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