Abstract. AIM:To assess and compare the roles of plasma and urine concentrations of neutrophil gelatinase associated lipocalin (NGAL) and Cystatin C for early diagnosis of septic acute kidney injury (AKI) in adult critically ill patients. METHODS: Patients were divided into three groups as sepsis-non AKI, sepsis-AKI and non sepsis-non AKI. Plasma samples for NGAL and Cystatin C were determined on admission and on alternate days and urinary samples were collected for every day until ICU discharge. RESULTS: One hundred fifty one patients were studied; 66 in sepsis-non AKI, 63 in sepsis-AKI, 22 in non-sepsis-non-AKI groups. Although plasma NGAL performed less well (AUC 0.44), urinary NGAL showed significant discrimination for AKI diagnosis (AUC 0.80) with a threshold value of 29.5 ng/ml (88% sensitivity, 73% specificity). Both plasma and urine Cystatin C worked well for the diagnosis of AKI (AUC 0.82 and 0.86, thresholds 1.5 and 0.106 mg/L respectively). CONCLUSION: Plasma and urinary Cystatin C and urinary NGAL are useful markers in predicting AKI in septic critically ill patients. Plasma NGAL raises in patients with sepsis in the absence of AKI and should be used with caution as a marker of AKI in septic ICU patients.
IntroductionLittle is known about whether there is any sex effect on chronic obstructive lung disease (COPD) exacerbations. This study is intended to describe the possible sex-associated differences in exacerbation profile in COPD patients.MethodsA total of 384 COPD patients who were hospitalized due to exacerbation were evaluated retrospectively for their demographics and previous and current exacerbation characteristics.ResultsThe study was conducted on 109 (28%) female patients and 275 (72%) male patients. The mean age was 68.30±10.46 years. Although females had better forced expiratory volume in 1 second and near-normal forced vital capacity, they had much impaired arterial blood gas levels (partial oxygen pressure [PO2] was 36.28 mmHg vs 57.93 mmHg; partial carbon dioxide pressure [PCO2] was 45.97 mmHg vs 42.49 mmHg; P=0.001), indicating severe exacerbation with respiratory failure. More females had two exacerbations and two hospitalizations, while more men had one exacerbation and one hospitalization. Low adherence to treatment and pulmonary embolism were more frequent in females. Females had longer time from the onset of symptoms till the admission and longer hospitalization duration than males. Comorbidities were less in number and different in women (P<0.05). Women were undertreated and using more oral corticosteroids.ConclusionCurrent data showed that female COPD patients might be more prone to have severe exacerbations, a higher number of hospitalizations, and prolonged length of stay for hospitalization. They have a different comorbidity profile and might be undertreated for COPD.
The aim of this study is to identify the factors affecting mortality in patients with chronic obstructive pulmonary disease (COPD) hospitalized with exacerbation. A COPD cohort study was designed. Demographic data, the reason of mortality, Charlson co-morbidity index (CCI), COPD comorbidity index (COTE), age, dyspnea, airway obstruction (ADO) index, modified ADO index and dyspnea, airway obstruction, smoking, exacerbation (DOSE) index, and their relationship with mortality were investigated. One hundred and forty COPD patients hospitalized with exacerbation were included in the study. Eighty-seven (62.15%) of the patients were alive and 53 (37.85%) of them were deceased. The number of patients with CCI ≥ 7 was none in living patients and 11 (20.8%) in the deceased group (p<0.001). The percentage of treatment compliant patients during stable conditions was lower in the deceased group (p<0.001). ADO and COTE indices were significantly higher in the deceased group. There was no difference in modified ADO and DOSE scores between the groups. Multivariate analysis showed that lung cancer, CCI 7, hypoxemia (PaO2 <60 mmHg), and longer admission to the intensive care unit were independently associated with 3.4, 4.4, 2.1, and 3.0-fold mortality, respectively (p <0.05). Additionally, COTE ≥ 4 and noncompliance to regular COPD treatment were found to be associated with shorter survival in Kaplan Meier analysis (p<0.05). In conclusion, comorbidities and most notably lung cancer was associated with mortality in COPD. Also, high CCI and COTE index were risk factors for increased mortality.
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