Proenkephalin A 119-159 (penKid) has been suggested as a marker of renal failure and poor outcome. We aimed to investigate the association of penKid on ICU admission with organ dysfunction and mortality in a mixed ICU population. In this retrospective, observational study, admission penKid levels from prospectively collected blood samples of consecutive patients admitted to four Swedish ICUs were analysed. The association of penKid with day-two sequential organ failure assessment (SOFA) scores and 30-day mortality was investigated using (ordinal) logistic regression. The predictive power of penKid for 30-day mortality and dialysis was assessed using the area under the receiver operating characteristic curve (AUC). Of 1978 included patients, 632 fulfilled the sepsis 3-criteria, 190 had a cardiac arrest, and 157 had experienced trauma. Admission penKid was positively associated with 30-day mortality with an odds ratio of 1.95 (95% confidence interval 1.75–2.18, p < 0.001), and predicted 30-day mortality in the entire ICU population with an AUC of 0.71 (95% confidence interval 0.68–0.73) as well as in the sepsis, cardiac arrest and trauma subgroups (AUCs of 0.61–0.84). Correction for admission plasma creatinine revealed that penKid correlated with neurological dysfunction. Plasma penKid on ICU admission is associated with day-two organ dysfunction and predictive of 30-day mortality in a mixed ICU-population, as well as in sepsis, cardiac arrest and trauma subgroups. In addition to being a marker of renal dysfunction, plasma penKid is associated with neurologic dysfunction in the entire ICU population, and cardiovascular dysfunction in sepsis.

中文翻译：

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入院重症监护病房时血浆脑啡肽原 A 119–159 是器官衰竭和 30 天死亡率的预测因子


脑啡肽原 A 119-159 (penKid) 被认为是肾衰竭和不良预后的标志物。我们的目的是调查 penKid 入 ICU 与混合 ICU 人群的器官功能障碍和死亡率之间的关系。在这项回顾性、观察性研究中，对入住瑞典四个 ICU 的连续患者前瞻性收集的血液样本中的入院 penKid 水平进行了分析。使用（顺序）逻辑回归研究 penKid 与第二天序贯器官衰竭评估 (SOFA) 评分和 30 天死亡率的关联。 penKid 对 30 天死亡率和透析的预测能力使用受试者工作特征曲线下面积 (AUC) 进行评估。在 1978 名患者中，632 名符合脓毒症 3 级标准，190 名心脏骤停，157 名经历过创伤。 penKid 入院与 30 天死亡率呈正相关，优势比为 1.95（95% 置信区间 1.75–2.18，p < 0.001），并预测整个 ICU 人群的 30 天死亡率，AUC 为 0.71（95%置信区间 0.68-0.73）以及脓毒症、心脏骤停和创伤亚组（AUC 0.61-0.84）。对入院血浆肌酐的校正显示 penKid 与神经功能障碍相关。入住 ICU 时的血浆 penKid 与 ICU 混合人群以及脓毒症、心脏骤停和创伤亚组的第二天器官功能障碍相关，并可预测 30 天的死亡率。除了作为肾功能障碍的标志物之外，血浆 penKid 还与整个 ICU 人群的神经功能障碍以及脓毒症中的心血管功能障碍相关。