IJCRR - Vol 08 Issue 12, June, 2016
CORRELATION OF MICROALBUMINURIA AND C-REACTIVE PROTEIN AS MARKERS OF SEPSIS
Author: Shruti R. Mulgund, Subodhini A. Abhang
Sepsis is one of the challenges for the doctors who treat critically ill patients. Delay in diagnosis and late administration of antibiotics have been shown to increase the mortality in this cohort.
Objective: This study was done to evaluate whether microalbuminuria can be used as a marker of sepsis and also to compare with the levels of C-reactive protein (CRP a traditional marker) of patients admitted in ICU. The study was carried out in the department of Biochemistry, B.J. Medical College and Sassoon general hospitals, Pune.
Method: 50 adult patients with ICU stay of more than 24 hrs were included in the study. 50 healthy and age, sex matched controls were also included in the study. Patients with pregnancy, menstruation, anuria, macroscopic hematuria, urinary tract infection, any renal disorder and marked proteinuria were excluded from the study. Blood and spot urine samples were collected on admission and after 24 hrs. Urinary microalbumin was measured in terms of albumin creatinine ratio (ACR) and serum CRP levels were measured on ICU admission (ACR1,CRP1) and after 24 hrs (ACR2,CRP2).
Results and Conclusion: In the study we observed that there was a marked correlation between ACR1 and CRP1 (r=0.786) and also ACR2 and CRP2 (0.787). There was a significant increase in the values of both the parameters on admission as compared to controls (p<0.001). Out of 50 patients, 35 showed increased levels of ACR and CRP levels whereas 15 showed decreased levels after 24 hrs. Patients showing decreased levels had better prognosis as compared to those showing increased levels. Thus we can conclude that ACR can be an effective marker for early detection of sepsis and can also be used to monitor the severity of the disease.
Keywords: Microalbuminuria, Critically ill, CRP, Systemic inflammation
Shruti R. Mulgund, Subodhini A. Abhang. CORRELATION OF MICROALBUMINURIA AND C-REACTIVE PROTEIN AS MARKERS OF SEPSIS International Journal of Current Research and Review. Vol 08 Issue 12, June, 21-24
1. Angus DC, Pereira CA, Silva E : Epidemiology of severe sepsis around the world. Endocr Metab Immune Disord Drug Targets 2006,6:207-212.
2. Jonathan Cohen: The immunopathogenesis of sepsis: Nature; Vol 420, December 2002; 885-891.
3. Aird WC: The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood 2003,101: 3765-3777.
4. Omar Abid, Qinghua Sun, Kerji Sugimoto, Dany Mercan, and Jean Louis Vincent: Predictive value of microalbuminuria in medical ICU patients. Chest/120/6 December,2001;1984-1988.
5. Remick DG, Kunkel RG, Larrick JW. Acute in vivo effects of human recombinant tumour necrosis factor. Lab invest 1987; 56; 583-590.
6. McCord J. Oxygen derived free radicals. New Horiz.1993;1: 70- 76. 7. Astiz ME, Degent GE, Lin RY et al. Microvascular function and rheologic changes in hyperdynamic sepsis. Crit Care Med 1995;23: 265-271.
8. Bone RC, Balk RA, Cerra FB. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. THE ACCP/SCCM consensus conference committee. Chest.1992;101:1644-1655.
9. George E. Nelson, Vidya Mave, and Amita Gupta : Biomarkers for sepsis : A Review with special Attention to India ; Biomed Res Int.2014;2014:264351.
10. Clyne B, Olshaker JS: The C-Reactive Protein. J. Emerg Med. 1999; 17: 1019-1025.
11. Aldo Luzzani, Enrico Polati, RomoloDorizzi, AlessioRungatscher, RaffaellaPavan, Alberto Merlini: Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003 vol 31,no.6; 1737-1741.
12. Yoshiaki Terao, Masafumi Takada, Takahiro Tanabe, Yuko Ando, Makoto Fukusaki, Koji Sumikawa : Microalbuminuria is a prognostic predictor in aneurysmal subarachnoid hemorrhage : Intensive Care Med ; 2007; 33; 1000-1006.
13. Nakamura M, Onoda T, Itai K, Ohsawa M, Satou K, Sakai T, Segawa T, Sasaki J, Tonari Y, Hiramori K, Okayama A, (2004). Association between serum C-reactive protein levels and microalbuminuria: A population based cross-sectional study innorthern Iwate, Japan. Intern Med.43: 919-925.
14. Basu S, Bhattacharya M, Chaterjee TK, Chaudhari S, Todi SK, Majumdar A. Microalbuminuria: A Novel biomarker of sepsis. Indian J Crit Care Med. 2010; 14(1): 22-28.
15. De Gaudio AR, Adembri C, Grechi S, Novelli GP. Microalbuminuria an early index of impairement of glomerular permeability in post-operative septic patients. Intensive Care Med. 2000; 26(9) 1364-1368.
16. Zhongheng Zhang, Baolong Lu, Hongying Ni, Xiaoyan Sheng, NiJin: Microalbuminuria can predict the development of acute kidney injury in critically ill septic patients. J Nephrol 2013; 26(4):724-730.
17. Dezier JF, Le Reun M, Poirier JY (1988) Usefulness of the urinary albumin / creatinine ratio in screening for microalbuminuria. La PresseMedicale 17/18: 897-900.
18. Lars-Olof Hanson et al. Current opinion in infect diseases 1997; 10; 196-201 Chetana Vaishnavi. Immunology and infectious diseases 1996; 6; 144
19. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret G-Y. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Critical Care Medicine. 2006;34(7):1996–2003.
20. Lobo SMA, Lobo FRM, Peres Bota D, et al. C-reactive protein levels correlate with mortality and organ failure in critically III patients. Chest. 2003;123(6):2043–2049.
21. Tschaikowsky K, Hedwig-Geissing M, Braun GG, RadespielTroeger M. Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis. Journal of Critical Care. 2011;26(1):54–64.
22. Tschaikowsky K, Hedwig-Geissing M, Schmidt J, Braun GG. Lipopolysaccharide-binding protein for monitoring of postoperative sepsis: complemental to C-reactive protein or redundant? PLoS ONE. 2011;6(8)e23615
23. Sakr Y, Burgett U, Nacul FE, Reinhart K, Brunkhorst F. Lipopolysaccharide binding protein in a surgical intensive care unit: a marker of sepsis?Critical Care Medicine.2008;36(7):2014–2022.
24. Parillo JE (1993) Pathogenic mechanisms of septic shock. N Engl J Med 328: 1471-1477.
25. Gopal S, Carr B, Nelson P. Does microalbuminuria predict illness severity ill patients on the intensive care unit ? A systematic review. Crit Care Med.2006;34:1805-10.
26. Thorevska N, Sabahi R, Upadya A, Manthous C, AmoatengAdjepong Y. Microalbuminuria in critically ill medical patients: Prevalence, predictors, and prognostic significance. Crit Care Med 2003;31:1075-81
27. Gosling P, Czyz J, Nitingale P, Manji M. Microalbuminuria in the intensive care unit: Clinical correlates and association with outcomes in 431 patients. Crit Care Med 2006;34(8):2158-66.