Garrido Pedro, Rovira Conxita, Cueto Pitter, Fort-Gallifa Isabel, Hernández-Aguilera Anna, Cabré Noemí, Luciano-Mateo Fedra, García-Heredia Anabel, Camps Jordi, Joven Jorge, Garcia Elisabeth, Vallverdú Immaculada
Intensive Care Unit, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
Clin Biochem. 2018 Nov;61:1-6. doi: 10.1016/j.clinbiochem.2018.08.010. Epub 2018 Aug 27.
Acute renal failure in patients with sepsis is associated with high mortality. Studies have highlighted alterations in serum paraoxonase-1 in severe infections. However, the published literature has no insight into the clinical evolution of these parameters in patients with sepsis and acute renal failure treated with extra-renal depuration techniques.
We studied 25 patients with sepsis and acute renal failure who were treated with continuous renal-replacement therapy. Blood for laboratory analyses was collected at days 0, 1, 2, 5, 7, and 10. We measured serum paraoxonase-1 activity and concentration, lipid profile, aminotransferase activities, pH, and lactate, urea, creatinine and C-reactive protein concentrations. Values were compared with those of 50 healthy individuals.
Patients with sepsis and acute renal failure had lower serum paraoxonase-1 activity, lower high-density lipoprotein cholesterol concentrations, and higher serum paraoxonase-1 concentrations than the control group. We found a significant inverse correlation between serum paraoxonase-1 concentrations and the Acute Physiology And Chronic Health Evaluation II score in survivors as well as non-survivors, and a significant inverse correlation between serum paraoxonase-1 concentrations and the Sequential Organ Failure Assessment score only in survivors. Extra-renal depuration techniques produced a further increase in this enzyme related to the duration of treatment, and to serum urea concentration.
Our results show an inverse relationship between the concentration of paraoxonase-1 and the disease severity of patients with renal failure caused by septic shock. These results highlight relationships between paraoxonase-1 and infectious diseases and sepsis, with insights into potential clinical evolution of treatment.
脓毒症患者的急性肾衰竭与高死亡率相关。研究强调了严重感染时血清对氧磷酶-1的变化。然而，已发表的文献并未深入探讨接受肾外净化技术治疗的脓毒症和急性肾衰竭患者这些参数的临床演变情况。
我们研究了25例接受连续性肾脏替代治疗的脓毒症和急性肾衰竭患者。在第0、1、2、5、7和10天采集用于实验室分析的血液。我们测量了血清对氧磷酶-1活性和浓度、血脂谱、转氨酶活性、pH值、乳酸、尿素、肌酐和C反应蛋白浓度。将这些值与50名健康个体的值进行比较。
脓毒症和急性肾衰竭患者的血清对氧磷酶-1活性较低，高密度脂蛋白胆固醇浓度较低，血清对氧磷酶-1浓度高于对照组。我们发现，在幸存者和非幸存者中，血清对氧磷酶-1浓度与急性生理与慢性健康状况评分II之间存在显著负相关，仅在幸存者中，血清对氧磷酶-1浓度与序贯器官衰竭评估评分之间存在显著负相关。肾外净化技术使这种酶随着治疗时间和血清尿素浓度进一步升高。
我们的结果表明，对氧磷酶-浓度与脓毒性休克所致肾衰竭患者的疾病严重程度之间存在负相关。这些结果突出了对氧磷酶-1与传染病和脓毒症之间的关系，并为治疗的潜在临床演变提供了见解。
