BACKGROUND Sepsis is a leading cause of death worldwide and a major challenge for physicians to predict and manage. Proenkephalin A 119-159 (penKid) is a reliable surrogate marker for the more unstable endogenous opioid peptide enkephalin, which has previously been shown to predict both acute and chronic kidney disease. The aim of this prospective observational study was to assess penKid as a predictor of acute kidney injury (AKI), multi-organ failure and mortality in sepsis among unselected sepsis patients presenting to the emergency department (ED). METHOD We enrolled 644 patients consecutively during office-hours (6 AM-6 PM) between December 1, 2013 and February 1, 2015. Fifty-six patients were excluded due to incomplete data. We measured penKid in 588 adult patients (patients under 18 years of age were excluded) with sepsis (≥2SIRS criteria + suspected infection) upon admission to the ED at Skåne University Hospital, Malmö, Sweden. Logistic regression analysis was used to relate levels of penKid at presentation to AKI, multi-organ failure, 28-day mortality and progression of renal SOFA subscore. Odds ratios are presented as the number of standard deviations from the mean of log-transformed penKid. RESULTS In age and sex adjusted models, penKid predicted AKI within 48 h and 7 days, but these associations were attenuated after additional adjustment for estimated creatinine-based glomerular filtration rate (eGFR). In models adjusted for age, sex and eGFR, penKid significantly predicted progression from rSOFA = 0 and ≤ 1 to higher rSOFA scores as well as multi-organ failure and mortality. In contrast, eGFR did not predict 28-day mortality. CONCLUSION PenKid is an effective predictor of renal injury, severe multi-organ failure and mortality in unselected sepsis patients presenting to the emergency department.

中文翻译：

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Proenkephalin a 119-159（penKid）-脓毒症急性肾损伤的新型生物标志物：一项观察性研究。

背景技术败血症是全球死亡的主要原因，也是医师预测和管理的主要挑战。前脑啡肽原A 119-159（penKid）是更不稳定的内源性阿片肽脑啡肽的可靠替代标志物，先前已证明该药物可预测急性和慢性肾脏疾病。这项前瞻性观察研究的目的是评估在急诊科（ED）未选定的脓毒症患者中，penKid作为急性肾损伤（AKI），多器官功能衰竭和脓毒症死亡率的预测指标。方法我们在2013年12月1日至2015年2月1日的办公时间（上午6点至下午6点）连续入组644名患者。由于资料不完整，排除了56名患者。我们在瑞典马尔默斯科讷大学医院接受急诊就诊的588名成年败血症（≥2SIRS标准+怀疑感染）的成年患者（排除18岁以下患者）中的penKid。使用Logistic回归分析将呈现时的penKid水平与AKI，多器官功能衰竭，28天死亡率和肾SOFA评分的进展相关联。奇数比表示为与对数转换的penKid的平均值相差的标准偏差的数量。结果在年龄和性别校正的模型中，penKid在48 h和7天内预测了AKI，但是在对基于肌酐的肾小球滤过率（eGFR）进行了进一步调整后，这些关联性减弱了。在针对年龄，性别和eGFR进行了调整的模型中，penKid显着预测了从rSOFA = 0和≤1到更高的rSOFA评分以及多器官衰竭和死亡率的进展。相反，eGFR不能预测28天的死亡率。结论PenKid是预测急诊科未选败血症患者肾损伤，严重多器官功能衰竭和死亡率的有效预测指标。