PenKid measurement at admission is associated with outcome in severely ill burn patients

François Dépret; Adrien Polina; Juliette Amzallag; Laure Fayolle-Pivot; Maxime Coutrot; Maïté Chaussard; Joachim Struck; Oliver Hartmann; Marion Jully; Alexandre Fratani; Haikel Oueslati; Alexandru Cupaciu; Sabri Soussi; Mourad Benyamina; Lucie Guillemet; Alexandre Mebazaa; Julien Textoris; Matthieu Legrand; PRONOBURN group

doi:10.1016/j.burns.2020.01.002

PenKid measurement at admission is associated with outcome in severely ill burn patients

Burns. 2020 Sep;46(6):1302-1309. doi: 10.1016/j.burns.2020.01.002. Epub 2020 Jan 25.

Authors

François Dépret¹, Adrien Polina², Juliette Amzallag², Laure Fayolle-Pivot³, Maxime Coutrot⁴, Maïté Chaussard², Joachim Struck⁵, Oliver Hartmann⁵, Marion Jully², Alexandre Fratani², Haikel Oueslati², Alexandru Cupaciu², Sabri Soussi², Mourad Benyamina², Lucie Guillemet², Alexandre Mebazaa¹, Julien Textoris⁶, Matthieu Legrand⁷; PRONOBURN group

Affiliations

¹ AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National De La Santé Et De La Recherche Médicale (INSERM), F-CRIN INICRCT Network, France.
² AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France.
³ Hospices Civils De Lyon, Edouard Herriot Hospital, Department of Anesthesiology and Critical Care, Burn Center Pierre Colson, Lyon, France.
⁴ AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France.
⁵ Sphingotec GmbH, Hennigsdorf, Germany.
⁶ Hospices Civils De Lyon, Edouard Herriot Hospital, Department of Anesthesiology and Critical Care, Burn Center Pierre Colson, Lyon, France; EA 7426 Pathophysiology of Injury-Induced Immunosuppression, University of Lyon1-Hospices Civils De Lyon-bioMérieux, Hôpital Edouard Herriot, Lyon, France.
⁷ AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National De La Santé Et De La Recherche Médicale (INSERM), F-CRIN INICRCT Network, France; Department of Anesthesiology and Perioperative Care, UCSF, San Francisco, USA. Electronic address: matthieu.legrand@ucsf.edu.

PMID: 31987659
DOI: 10.1016/j.burns.2020.01.002

Abstract

Background: Proenkephalin A 119-159 (penKid) has been proposed as a sensitive biomarker of renal function. This study evaluated the association of concentrations of plasma penKid with death and risk of acute kidney injury (AKI) in severely ill burn patients.

Methods: A prospective observational study in two centers with severely ill adult burn patients was conducted. The inclusion criteria were total body surface area (TBSA) burns >15%, with burn injury occurring <72 h before intensive care unit (ICU) admission and plasma sample taken at admission. The primary endpoint was 90-day mortality. The secondary endpoints were AKI and a combined endpoint of 90-day mortality and/or AKI. Mortality was also evaluated in the sub-group of patients with sub-clinical AKI, defined as a patient without AKI but with elevated penKid.

Results: A total of 113 consecutive patients were enrolled. The median age was 48 years (Interquartile range [IQR] 33-64), the median burn TBSA was 35% (IQR 25-53), and 90-day mortality was 31.9%. Thirty-one percent of the patients had AKI, and 41.6% of patients had the combined endpoint. There was a stepwise decrease in survival from patients without AKI, sub-AKI, and with AKI (survival rate 90.0% [95% CI 82.7-97.9], 66.7% [95% CI 48.1-92.4], and 31.4% [95% CI 19.3-51.3], respectively, p < 0.001). Plasma penKid concentration was significantly higher in non-survivors compared to survivors (86.9 pmol/L [IQR 53.3-166.1] versus 52.9 pmol/L [IQR 37.1-70.7]; p = 0.0001) and in patients with AKI compared to patients without AKI (86.4 pmol/L [IQR 56.5-153.4] versus 52.5 pmol/L [IQR 35.5-71.2]; p < 0.001). Penkid provided added value on top of serum creatinine (Screat) and Sepsis Related Organ Failure Assessment (SOFA) scores to predict 90-day mortality (combined c-index of 0.738 versus 0.707; p = 0.024 and 0.787 versus 0.752; p < 0.001).

Conclusions: Plasma penKid concentration at admission was associated with an increased risk of death in burn patients. PenKid has additional prognostic value on top of Screat and SOFA to predict 90-day mortality.

Keywords: Acute kidney injury; Biomarkers; Burn patients; Mortality; Proenkephalin.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury / blood
Acute Kidney Injury / epidemiology*
Acute Kidney Injury / therapy
Adult
Aged
Biomarkers / blood
Body Surface Area
Burns / blood*
Creatinine / blood
Enkephalins / blood*
Female
Humans
Intensive Care Units
Length of Stay / statistics & numerical data
Male
Middle Aged
Mortality*
Organ Dysfunction Scores
Peptide Fragments / blood*
Prospective Studies
Protein Precursors / blood*
Renal Replacement Therapy

Substances

Biomarkers
Enkephalins
Peptide Fragments
Protein Precursors
proenkephalin
Creatinine