ABSTRACT
Neutrophil gelatinase-associated lipocalin (NGAL) is a protein of lipocalin family highly expressed in various pathologic states and is an early biomarker of acute kidney injury in cardiac surgery. We performed an observational study to evaluate the role of NGAL in predicting postoperative intensive care stay in high-risk patients undergoing cardiac surgery. We enrolled 27 consecutive patients who underwent high-risk cardiac surgery with cardiopulmonary bypass. Urinary NGAL (uNGAL) was measured before surgery, at intensive care unit (ICU) arrival and 24 h later. Univariate and multivariate predictors of ICU stay were performed. uNGAL was 18.0 (8.7-28.1) ng/mL at baseline, 10.7 (4.35-36.0) ng/mL at ICU arrival and 29.6 (9.65-29.5) 24 h later. The predictors of prolonged ICU stay at the multivariate analysis were body mass index (BMI), uNGAL 24 h after surgery, and aortic cross-clamp time. The predictors of high uNGAL levels 24 h after at a multivariate analysis were preoperative uNGAL and logistic European System for Cardiac Operative Risk Evaluation. At a multivariate analysis the only independent predictors of prolonged ICU stay were BMI, uNGAL 24 h after surgery and aortic cross-clamp time.
Subject(s)
Acute-Phase Proteins/physiology , Acute-Phase Proteins/urine , Adult , Aged , Body Mass Index , Cardiac Surgical Procedures , Female , Humans , Intensive Care Units , Length of Stay , Lipocalins/physiology , Lipocalins/urine , Male , Middle Aged , Multivariate Analysis , Proto-Oncogene Proteins/physiology , Proto-Oncogene Proteins/urineSubject(s)
Infant, Newborn , Bacteremia , Multiple Organ Failure/immunology , Immune System , Intensive Care Units, Neonatal , Sepsis/epidemiology , Shock, Septic , Anti-Bacterial Agents/therapeutic use , Cytokines/physiology , Diagnosis, Differential , Hyaline Membrane Disease/diagnosis , Infant, Low Birth Weight , Infant, Premature, Diseases , Pneumonia, Bacterial/diagnosis , Acute-Phase Proteins/physiology , Risk Factors , Sepsis/complications , Sepsis/diagnosis , Sepsis/drug therapy , Sepsis/immunology , Sepsis/physiopathologySubject(s)
Humans , Animals , Mice , Rats , Adjuvants, Immunologic/physiology , Inflammation/physiopathology , Interleukin-6/pharmacology , Neurosecretory Systems/physiopathology , Hypothalamic Hormones/physiology , Hypothalamic Hormones/immunology , Interleukin-6/immunology , Interleukin-6/physiology , Neuroendocrinology/trends , Neuropeptides/physiology , Neuropeptides/immunology , Neurosecretory Systems/drug effects , Neurosecretory Systems/physiology , Acute-Phase Proteins/biosynthesis , Acute-Phase Proteins/physiologyABSTRACT
Septic shock is the host's inflammatory response to infection. There are multiple endogenous mediators responsible for the pathogenesis of septic shock. Cytokines, nitric oxide and prostaglandins are some of the major mediators. The term sepsis syndrome allows for an earlier diagnosis and treatment. Management of septic shock is focused in maintaining hemodynamic stability and an adequate oxygen delivery and utilization. Careful attention to each organ-system is of paramount importance to prevent complications and improve outcome. Experimental therapies to modulate the inflammatory response are promising.