Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 41, Issue 1, Pages 62-75Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/ajkd.2003.50024
Keywords
sepsis; renal failure
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Funding
- NHLBI NIH HHS [HL69722] Funding Source: Medline
- NIDDK NIH HHS [DK59793] Funding Source: Medline
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R21HL069722] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [R01DK059793] Funding Source: NIH RePORTER
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Background: Acute renal failure (ARF), a common and serious complication in patients with septic shock, has high mortality. Recent data suggest that proinflammatory cytokines may contribute to sepsis-associated ARK Methods: To examine the role of proinflammatory cytokines, we evaluated 537 patients enrolled in the placebo arm of the Norasept II study, of whom 112 patients (20%) developed ARE Results: By univariate analysis, the following factors were significantly associated with the development of ARF: male sex, younger age, increased heart rate, higher Acute Physiology and Chronic Health Evaluation II score, oliguria, increased blood urea nitrogen level, increased serum creatinine (Scr) level, decreased arterial pH, and increased serum potassium level. Although there were no statistically significant differences in serum levels of tumor necrosis factor-alpha (TNF-alpha) or interleukin-6 between patients with and without ARF, elevated serum levels of the two soluble TNF-alpha receptors (S-TNF-RI and S-TNF-RII) were strongly associated with the development of ARF (S-TNF-RI, 25 +/- 16 versus 18 +/- 13 ng/mL; P = 0.00006; S-TNF-RII, 25 +/- 21 versus 18 +/- 17 ng/mL; P = 0.0007). Using forward stepwise regression analysis, elevated S-TNF-R level remained an independent predictor for ARF, even when we limited our analysis to patients with Scr levels of 1.4 mg/dL or less (less than or equal to124 mumol/L) at study entry, suggesting that decreased renal clearance of S-TNF-R alone cannot account for this association. Elevated S-TNF-R level also was an independent predictor of mortality among patients developing ARF. Conclusion: S-TNF-R level is an independent predictor for the development of ARF and mortality. We speculate that elevated S-TNF-R levels may reflect a more intense inflammatory response.
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