Evaluation of the value of early use of norepinephrine infusion in the improvement of renal function in patients with severe sepsis with early renal impairment using cystatin C, a sensitive renal marker
SOBHY, AMR;
Abstract
Introduction
Acute renal failure occurs in ∼23% of patients with severe sepsis. The combination of acute renal
failure and severe sepsis may carry a mortality of up to 70%. Several studies have demonstrated
that serum cystatin C level is a better marker of glomerular fi ltration rate ( GFR) compared
with serum creatinine, particularly for individuals with small-to-moderate decreases in GFR.
To maintain organ perfusion in sepsis, a mean arterial pressure of 65 mmHg should be
maintained with fl uid therapy and vasopressors. Marked delays in initiation are associated
with increase in mortality risk in patients with septic shock.
Patients and methods
Sixty patients enrolled in the study proved to have severe sepsis with early renal impairment.
Patients were randomly allocated into one of two groups (30 patients each): the norepinephrine
infusion group (the N group) and the control group (the C group). The N group received
norepinephrine infusion+conventional treatment for severe sepsis, whereas the C group was
treated with conventional treatment for severe sepsis according to the latest Surviving Sepsis
Campaign. For each patient, the following data were collected: age, body weight, hemodynamic
changes, urine output, renal function as detected from levels of the sensitive renal marker
cystatin C and from serum creatinine levels, blood urea nitrogen, and estimated GFR ( eGFR).
Results
There was a statistically signifi cant increase in blood pressure and urine output in the N group
at 10 min and 2 h, respectively, after norepinephrine infusion and on comparing subsequent
measures with baseline values (T0) and also when compared with corresponding values in
the C group. In addition, patients in the N group showed a statistically signifi cant decrease
in serum cystatin C levels and an increase in eGFR based on cystatin C levels after 2 h of
norepinephrine infusion, compared with baseline values and values in the C group, denoting
marked improvement in GFR. Serum creatinine levels, blood urea nitrogen levels, and eGFR
based on serum creatinine levels showed no signifi cant difference in either group whether
compared with baseline of the same group or when comparing both groups together.
Conclusion
The results this study demonstrate that early continuous infusion of norepinephrine at 0.5–1 μg/
kg/min may have a renoprotective role in septic patients with early renal impairment detected
by levels of the sensitive renal marker cystatin C.
Acute renal failure occurs in ∼23% of patients with severe sepsis. The combination of acute renal
failure and severe sepsis may carry a mortality of up to 70%. Several studies have demonstrated
that serum cystatin C level is a better marker of glomerular fi ltration rate ( GFR) compared
with serum creatinine, particularly for individuals with small-to-moderate decreases in GFR.
To maintain organ perfusion in sepsis, a mean arterial pressure of 65 mmHg should be
maintained with fl uid therapy and vasopressors. Marked delays in initiation are associated
with increase in mortality risk in patients with septic shock.
Patients and methods
Sixty patients enrolled in the study proved to have severe sepsis with early renal impairment.
Patients were randomly allocated into one of two groups (30 patients each): the norepinephrine
infusion group (the N group) and the control group (the C group). The N group received
norepinephrine infusion+conventional treatment for severe sepsis, whereas the C group was
treated with conventional treatment for severe sepsis according to the latest Surviving Sepsis
Campaign. For each patient, the following data were collected: age, body weight, hemodynamic
changes, urine output, renal function as detected from levels of the sensitive renal marker
cystatin C and from serum creatinine levels, blood urea nitrogen, and estimated GFR ( eGFR).
Results
There was a statistically signifi cant increase in blood pressure and urine output in the N group
at 10 min and 2 h, respectively, after norepinephrine infusion and on comparing subsequent
measures with baseline values (T0) and also when compared with corresponding values in
the C group. In addition, patients in the N group showed a statistically signifi cant decrease
in serum cystatin C levels and an increase in eGFR based on cystatin C levels after 2 h of
norepinephrine infusion, compared with baseline values and values in the C group, denoting
marked improvement in GFR. Serum creatinine levels, blood urea nitrogen levels, and eGFR
based on serum creatinine levels showed no signifi cant difference in either group whether
compared with baseline of the same group or when comparing both groups together.
Conclusion
The results this study demonstrate that early continuous infusion of norepinephrine at 0.5–1 μg/
kg/min may have a renoprotective role in septic patients with early renal impairment detected
by levels of the sensitive renal marker cystatin C.
Other data
Title | Evaluation of the value of early use of norepinephrine infusion in the improvement of renal function in patients with severe sepsis with early renal impairment using cystatin C, a sensitive renal marker | Authors | SOBHY, AMR | Keywords | cystatin C;sepsis;renal impairment;norepinephrine | Issue Date | 1-Mar-2017 | Journal | Ain Shams Journal of Anesthesiology | Volume | 10 | Issue | 1 | Start page | 46 | End page | 53 |
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