Elevated leukocyte count and creatinine predict mortality associated with AKI

A new study published in Journal of International Urology and Nephrology suggests that higher creatinine levels and leukocyte counts were linked to poor outcomes in sepsis ICU patients.

Acute kidney damage (AKI) is one of the most common pathophysiologic illnesses seen in hospitalized patients, and sepsis is commonly linked in its pathophysiology. Reactive oxygen species (ROS) appear to have a substantial role in sepsis-induced AKI. Proposed processes include cell membrane lipid peroxidation, protein denaturation, and direct DNA damage, all of which are harmful. These alterations are indicative of renal oxidative damage. As a result, Alaa Efat and colleagues undertook this study to assess the antioxidant effects of indirect bilirubin and uric acid on the outcomes of sepsis-related AKI.

For this study serum levels of uric acid, bilirubin (mainly indirect), and procalcitonin were measured in 98 patients hospitalized to the critical care unit of a large tertiary care institution with sepsis and AKI. The key outcomes investigated were the requirement for hemodialysis and mortality.

The key findings of this study were as follow:

1. Thirty-two (33%) individuals had AKI and required hemodialysis (HD).

2. When compared to those who did not require HD, these patients had higher SOFA ratings (p 0.001) and lower levels of indirect bilirubin (p 0.001).

3. Serum uric acid levels did not differ statistically significantly.

4. Creatinine level, leukocyte count, and total & indirect bilirubin levels were found to be significant predictors of patient mortality in a logistic regression study.

In conclusion, raised roundabout bilirubin levels appear to make a possibly defensive difference, however given the restricting impact of complete bilirubin levels and that of higher backhanded bilirubin levels, more exploration is expected to recognize the likely antioxidative impacts of circuitous bilirubin in sepsis, especially in accordance with kidney injury, as well as potential future treatments focusing on the pathways it impacts.

Reference:

Efat, A., Shoeib, S., Ebrahim, E., Kassemy, Z., Bedair, H. M., & Abozenah, M. (2022). Impact of indirect bilirubin and uric acid on outcomes of sepsis-associated acute kidney injury (sAKI). In International Urology and Nephrology. Springer Science and Business Media LLC. https://doi.org/10.1007/s11255-022-03232-2