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Burns. 2020 Jan 24. pii: S0305-4179(19)30254-2. doi: 10.1016/j.burns.2020.01.002. [Epub ahead of print]

PenKid measurement at admission is associated with outcome in severely ill burn patients.

Author information

1
AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National De La Santé Et De La Recherche Médicale (INSERM), F-CRIN INICRCT Network, France.
2
AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France.
3
Hospices Civils De Lyon, Edouard Herriot Hospital, Department of Anesthesiology and Critical Care, Burn Center Pierre Colson, Lyon, France.
4
AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France.
5
Sphingotec GmbH, Hennigsdorf, Germany.
6
Hospices Civils De Lyon, Edouard Herriot Hospital, Department of Anesthesiology and Critical Care, Burn Center Pierre Colson, Lyon, France; EA 7426 Pathophysiology of Injury-Induced Immunosuppression, University of Lyon1-Hospices Civils De Lyon-bioMérieux, Hôpital Edouard Herriot, Lyon, France.
7
AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National De La Santé Et De La Recherche Médicale (INSERM), F-CRIN INICRCT Network, France; Department of Anesthesiology and Perioperative Care, UCSF, San Francisco, USA. Electronic address: matthieu.legrand@ucsf.edu.

Abstract

BACKGROUND:

Proenkephalin A 119-159 (penKid) has been proposed as a sensitive biomarker of renal function. This study evaluated the association of concentrations of plasma penKid with death and risk of acute kidney injury (AKI) in severely ill burn patients.

METHODS:

A prospective observational study in two centers with severely ill adult burn patients was conducted. The inclusion criteria were total body surface area (TBSA) burns >15%, with burn injury occurring <72 h before intensive care unit (ICU) admission and plasma sample taken at admission. The primary endpoint was 90-day mortality. The secondary endpoints were AKI and a combined endpoint of 90-day mortality and/or AKI. Mortality was also evaluated in the sub-group of patients with sub-clinical AKI, defined as a patient without AKI but with elevated penKid.

RESULTS:

A total of 113 consecutive patients were enrolled. The median age was 48 years (Interquartile range [IQR] 33-64), the median burn TBSA was 35% (IQR 25-53), and 90-day mortality was 31.9%. Thirty-one percent of the patients had AKI, and 41.6% of patients had the combined endpoint. There was a stepwise decrease in survival from patients without AKI, sub-AKI, and with AKI (survival rate 90.0% [95% CI 82.7-97.9], 66.7% [95% CI 48.1-92.4], and 31.4% [95% CI 19.3-51.3], respectively, p < 0.001). Plasma penKid concentration was significantly higher in non-survivors compared to survivors (86.9 pmol/L [IQR 53.3-166.1] versus 52.9 pmol/L [IQR 37.1-70.7]; p = 0.0001) and in patients with AKI compared to patients without AKI (86.4 pmol/L [IQR 56.5-153.4] versus 52.5 pmol/L [IQR 35.5-71.2]; p < 0.001). Penkid provided added value on top of serum creatinine (Screat) and Sepsis Related Organ Failure Assessment (SOFA) scores to predict 90-day mortality (combined c-index of 0.738 versus 0.707; p = 0.024 and 0.787 versus 0.752; p < 0.001).

CONCLUSIONS:

Plasma penKid concentration at admission was associated with an increased risk of death in burn patients. PenKid has additional prognostic value on top of Screat and SOFA to predict 90-day mortality.

KEYWORDS:

Acute kidney injury; Biomarkers; Burn patients; Mortality; Proenkephalin

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