"The role of C-reactive protein, ferritin, and uric acid in predicting dialysis requirement in patients with acute kidney injury: A prospective study"
Project no. 32338 · Status: Kapanmış (Yayın bekleniyor) · 2024
Summary
<p>Objective: Acute kidney injury (AKI) is a condition frequently encountered in the emergency department and requires rapid intervention. ABI is characterized by sudden deterioration of renal function, which can be caused by various etiological factors. This condition increases the morbidity and mortality of patients and creates a significant burden on healthcare systems. In this context, determining the need for dialysis in patients diagnosed with ABH is of critical importance for clinical practice. Dialysis requirement is an important factor affecting the prognosis of patients and the role of serum CRP, ferritin and uric acid levels in this regard has not yet been fully elucidated. The aim of this study was to investigate the relationship between the need for dialysis and these biochemical parameters in patients admitted to the emergency department of Ege University Faculty of Medicine (EÜTF) Department of Emergency Medicine and diagnosed with ABH. Materials and Methods: This prospective study was conducted on patients aged 18 years and older who were diagnosed with acute kidney injury (AKI) and hospitalized in EÜTF Emergency Department. The dependent variable of the study was the need for dialysis. In the light of the data obtained in the literature on the need for dialysis in patients with ABI, the sample size in this study was calculated based on a 50% prevalence value and a total of 382 patients were aimed to be reached. Blood samples were collected from 388 individuals and 361 blood samples were analyzed by the laboratory as deemed appropriate. The data collection process and biochemical examinations were carried out between June 2024 and August 2024. Ferritin, uric acid and CRP levels at admission were evaluated as independent variables. Additional factors such as ABH stage, presence of pre-diagnosed renal disease, demographic and clinical characteristics, diagnoses received during emergency department follow-up, vital parameters, blood gas values, biochemical parameters, hospitalization status and duration, and medication use were also analyzed. Results: The mean age of the study group was 71.11 ± 12.96 years. 57.9% (209) of the patients were male. The mortality rates of the patients in the emergency department and in the hospitalized unit within 48 hours and 1 month were 11 (3.0%) and 103 (28.5%), respectively. The mean mortality duration was 17.53±19.1 days. Thirty-four (9.4%) of the patients received hemodialysis. When patients with ferritin levels between 30 and 400 were compared with patients with ferritin levels above 400, the mortality risk of patients with lower ferritin levels was 16.5 times higher (HR=16.593, 95% Cl(2.028-141.742), p=0.009). Patients with low GFR (GFR < 15) had a mortality risk approximately 1.83 times higher than those with normal GFR (HR=1.830, 95% Cl(1.086-3.081), p=0.023). In the 30-day mortality ROC analysis for ferritin levels, the ferritin cut-off value was determined as 320.5 µg/L. This cut-off VI value predicts mortality with 64.1% sensitivity and 66.7% specificity. The cut-off value of uric acid for hemodialysis requirement was 8.4 mg/dL with 58.8% sensitivity and 58.7% specificity. Uric acid cut-off value of 9.57 mg/dL for predicting 48-hour mortality is 72.7% sensitive and 71.7% specific. Uric acid cut-off value of 8.23 mg/dL for predicting 30-day mortality is 58.3% sensitive and 59.3% specific. CRP cut-off value of 28.5 (mg/L) for predicting 30-day mortality is 68.9% sensitive and 58.5% specific. Conclusion: Ferritin and CRP parameters can be used to predict 30-day mortality in patients with ABH. In patients with ABH, uric acid parameter is important in predicting the need for hemodialysis and 48-hour and 30-day mortality. The fact that the need for hemodialysis after ABH is more frequent in patients with renal etiology indicates that these patients should be closely monitored. In our study, most of the cases were ABH patients with prerenal etiology. It is important to control comorbidities in these patients. Intervention may change if there are additional risk factors and fluid management should be emphasized in this patient group. The most important cause of death in ABH is septic shock. Septic shock and sepsis are important clinical pictures explaining the etiology of ABH. In our study, prerenal causes were prominent in the etiology of ABH. Hemodialysis was received more frequently in patients with renal etiology. Keywords: Ferritin, critically ill patient, emergency department, mortality</p>