Journal of Translational Critical Care Medicine最新文献

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Biomarkers in acute kidney injury and cirrhosis 急性肾损伤和肝硬化的生物标志物

Journal of Translational Critical Care Medicine Pub Date : 2024-06-01 DOI: 10.1097/jtccm-d-23-00014

C. Lima, Etienne Macedo

{"title":"Biomarkers in acute kidney injury and cirrhosis","authors":"C. Lima, Etienne Macedo","doi":"10.1097/jtccm-d-23-00014","DOIUrl":"https://doi.org/10.1097/jtccm-d-23-00014","url":null,"abstract":"The use of biomarkers for managing acute kidney injury (AKI) is still not routinely used in clinical practice due to the lack of robust evidence on their impact on patient outcomes. In cirrhotic patients’ serum creatinine (sCr) limitations are more pronounced, as malnutrition, altered volume status, and muscle mass loss are more frequently encountered. This can make the diagnosis of AKI challenging, and therefore, additional markers may be necessary for a more accurate evaluation. This review will discuss the renal biomarkers of filtration and injury in patients with cirrhosis, focusing on their possible clinical application. A combined evaluation of a panel of biomarkers could provide a comprehensive assessment of kidney function and help distinguish between hepatorenal syndrome and chronic kidney disease in situations involving liver or combined liver and kidney transplantation. We will demonstrate that some biomarkers have more evidence of their utility in cirrhotic patients, such as cystatin C for filtration. In contrast, others require further studies, such as proenkephalin, which is only used in liver transplantation and appears superior to cystatin C as the inflammatory state does not influence it in cirrhotic patients. Interleukin-18 (IL-18) as a biomarker of injury in renal dysfunction in cirrhotic patients is still unclear despite extensive analysis in various scenarios, including liver diseases. On the other hand, the utility of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) is well established in renal dysfunction and evaluating other outcomes.","PeriodicalId":509169,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"25 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identification of fluid overload in critically ill children: fluid status, the missing vital sign 识别重症儿童的体液超负荷：体液状态--缺失的生命体征

Journal of Translational Critical Care Medicine Pub Date : 2024-06-01 DOI: 10.1097/jtccm-d-23-00009

Michelle C. Starr, Haley I Arrowood, Eliza Weston, Jennifer Chmielewski, Andrew Hopwood, Brianna M. Liberio, David T. Selewski, Danielle E. Soranno

{"title":"Identification of fluid overload in critically ill children: fluid status, the missing vital sign","authors":"Michelle C. Starr, Haley I Arrowood, Eliza Weston, Jennifer Chmielewski, Andrew Hopwood, Brianna M. Liberio, David T. Selewski, Danielle E. Soranno","doi":"10.1097/jtccm-d-23-00009","DOIUrl":"https://doi.org/10.1097/jtccm-d-23-00009","url":null,"abstract":"Fluid overload, defined as a state of pathologic fluid excess or positive fluid balance, is increasingly recognized as a deleterious state in critically ill infants and children. Fluid overload is common, and mounting evidence shows that it is associated with increased mortality, organ dysfunction, and prolonged need for mechanical ventilation. Despite studies showing adverse outcomes associated with fluid overload, awareness of fluid overload remains limited, especially in small children and infants. Fluid overload as a biomarker and vital sign in the clinical setting has also not been routinely adopted despite its link with morbidity and mortality, and it remains underrecognized by providers. In this review, we first discuss the definition of fluid balance and fluid overload, then briefly review existing data on associations of fluid overload with outcomes in critically ill infants and children. We then consider existing and new data on recognition of fluid overload in critically ill children and infants before closing with the need for better awareness of fluid overload, and a discussion of future research directions and gaps in the field.","PeriodicalId":509169,"journal":{"name":"Journal of Translational Critical Care Medicine","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0