Plasma neutrophil gelatinase-associated lipocalin and adverse outcome in critically ill patients with ventilatory support.

OBJECTIVE: Plasma neutrophil gelatinase-associated lipocalin (pNGAL) has been introduced as an early and sensitive biomarker of acute kidney injury (AKI), with an increased risk for renal replacement therapy (RRT) and adverse outcome in selected critically ill patient groups. Acute respiratory failure is the most common organ dysfunction in critically ill patients with an increased risk for AKI. Accordingly, we hypothesized that pNGAL would independently predict adverse outcome in a heterogeneous group of critically ill adult patients with acute respiratory failure. DESIGN AND SETTING: Prospective, multi-centre study in 25 Finnish intensive care units. PATIENTS AND METHODS: pNGAL was measured from critically ill patients with acute respiratory failure. We evaluated the predictive value of pNGAL for RRT, and hospital and 90-day mortality first separately, second in addition to the Simplified Acute Physiology Score (SAPS II), and third to RIFLE (Risk, Injury, Failure, Loss, End-Stage Renal Disease) AKI classification. Additionally, we assessed the factors associated with pNGAL by linear regression analysis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 369 patients. Median (interquartile range) baseline pNGAL was 169 (92-370) ng/ml. The areas under receiver operating characteristic curves of baseline pNGAL were as follows: 0.733 [95% confidence interval (CI) 0.656-0.810] for RRT, 0.627 (95% CI 0.561-0.693) for hospital, and 0.582 (95% CI 0.520-0.645) for 90-day mortality. Present infection, baseline creatinine, operative status, and pancreatitis were independently associated with baseline pNGAL. CONCLUSIONS: Baseline pNGAL gives no additional value into prediction of hospital and 90-day mortality compared with RIFLE or SAPS II, and has only moderate predictive power regarding RRT in critically ill adult patients with acute respiratory failure.

Self-aggregation of cationic surfactants onto oxidized cellulose fibers and coadsorption of organic compounds.

In this work, the adsorption of cationic surfactant and organic solutes on oxidized cellulose fibers bearing different amounts of carboxylic moieties was investigated. The increase in the amount of -COOH groups on cellulose fibers by TEMPO oxidation induced a general rise in surfactant adsorption. For all tested conditions, that is, cellulose oxidation level and surfactant alkyl chain length (C12 and C16), adsorption isotherms displayed a typical three-region shape with inversion of the substrate zeta-potential which was interpreted as reflecting surfactant adsorption and aggregation (admicelles and hemimicelles) on cellulose fibers. The addition of organic solutes in surfactant/cellulose systems induced a decrease in surfactant cac on the cellulose surface thus favoring surfactant aggregation and the formation of mixed surfactant/solute assemblies. Adsorption isotherms of organic solutes on cellulose in surfactant/cellulose/solute systems showed that solute adsorption is strictly correlated to (i) the surfactant concentration, solute adsorption increases up to the surfactant cmc, where solute partitioning between the cellulose surface and free micelles causes a drop in adsorption, and to (ii) solute solubility and functional groups. The specific shape of solutes adsorption isotherms at a fixed surfactant concentration was interpreted using a Frumkin adsorption isotherm, thus suggesting that solute uptake on cellulose fibers is a coadsorption and not a partitioning process. Results presented in this study were compared with those obtained in a previous work investigating solute adsorption in anionic surfactant/cationized cellulose systems to better understand the role of surfactant/solute interactions in the coadsorption process.