RESUMO
Objective To assess and compare the roles of plasma concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis and treatment of septic acute kidney injury (AKI) in adult Surgical critically ill patient . Methods One hundred patients were divided into two groups ,the group of 63 cases of AKI and AKI group of 37 cases ,plasma NGAL and Cystatin C level of the 2 groups were determined by the method of enzyme‐linked immunosorbent (ELISA) ,latex en‐hanced immune turbidimetry (PETIA) respectively on arrival in the surgical intensive care unit(SICU) (T0 ) and 24 h after arrival in SICU(T1 ) .Results Compared with patients in non AKI group ,both plasma NGAL and Cystatin C level of patients in AKI group on T0 and T1 increased significantly ,the difference between the two groups had significant statistical difference (P<0 .01);Although ,plasma NGAL on T1 performed less well (AUC=0 .69) ,with a threshold value of 92 ng/mL(70 .3% sensitivity ,57%specificity) .Plasma NGAL showed significant discrimination for AKI diagnosis (AUC=0 .85) with a threshold value of 65 .95 ng/mL(81 .8% sensitivity ,76 .2% specificity) on T0 .Both plasma Cystatin C on T0 and T1 worked well for the diagnosis of AKI (AUC=0 .90 ,0 .88 ,thresholds 1 .49 and 1 .47 mg/L ,respectively) ,with diagnostic sensitivity of 89 .2% ,82 .5% respectively ,speci‐ficity of 83 .8% ,76 .2% respectively .Conclusion Plasma NGAL and Cystatin C are useful markers in predicting AKI in surgical critically ill patients ,the early diagnosis value of plasma Cystatin C for AKI is better than plasma NGAL on arrival in the surgical intensive care unit .
RESUMO
The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)