Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Antithrombin III Protects Against Acute Kidney Injury in Septic Elderly Patients
20 Pages Posted: 19 Mar 2019
More...Abstract
The elderly are the primary age group of acute kidney injury (AKI). The predictive value of Antithrombin III (ATIII) level in preventing AKI among septic elderly patients has not been studied. The purpose of this study was to evaluate the value of ATIII in predicting AKI nondevelopment and prognosis in septic elderly patients under ICU settings. This is a retrospective study enrolling 107 elderly patients with sepsis who were admitted to ICUs from October 2015 to March 2018. Assessment of renal function was performed daily by measuring serum creatinine level and urine output. The ATIII level was obtained within the first 48 hours of the diagnosis of sepsis (ATIII1). The results were presented using descriptive statistics and area under the receiver operating characteristic curve (AUC-ROC). P value was set 0.05. Among all enrolled patients, 29 (27.1%) developed AKI. The ATIII level was a predictor of AKI nondevelopment (AUC-ROC =0.729, and sensitivity 0.700and specificity0.714). The ATIII/Cr ratio was also a predictor of AKI nondevelopment (AUC-ROC =0.971, and sensitivity 0.900and specificity1). The accuracy of ATIII and ATIII/Cr in predicting survival was intermediate, with AUC-ROC of 0.681 and 0.804 repectively, sensitivity ranging between 0.802 and 0.596, and specificity between 0.542 and 0.875. The ATIII level demonstrated excellent ability in predicting AKI nondevelopment in septic elderly patients in ICUs. Patients were divided into low ATIII group and high ATIII group using 66.95 or 55.7 as cutoff value. In comparison, ICU stay was significantly lower in the high ATIII group(p=0.020 and 0.049, repectively. Off mechanical ventilation time, off CRRT time, and survival time were significantly higher in high ATIII group (p=0.049,0.048,0.014 using 66.95 as cutoff and 0.041,0.036,0.021 using 55.7 as cutoff).This study suggests that ATIII protects against acute kidney injury in septic elderly patients. Lower ATIII predicts worse prognosis.
Funding: This project was supported by a grant from the Important and weak subject construction project of Shanghai Health and Family Planning System (No: 2016ZB0205) 2016ZB0205), grants from Shanghai science and technology committee scientific and technological support project (No:18411950600 and No:18411950602) and a grant from Clinical Research Innovation Plan of Shanghai General Hospital(CTCCR-2016B01).
Declaration of Interest: The authors declare that they have no competing interests.
Ethical Approval: Ethics approval was obtained from Shanghai General Hospital Instutional Review Board (reference number [2018]KY004).
Keywords: Antithrombin III; acute kidney injury; biomarker
Suggested Citation: Suggested Citation