Impact of sepsis on the urinary level of interleukin-18 and cystatin C in critically ill neonates
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Urinary interleukin-18 (uIL-18) and cystatin C (uCysC) are biomarkers of acute kidney injury (AKI). We hypothesized that in non-AKI neonates, the level of uIL-18 and uCysC would be higher in those with sepsis compared to those without sepsis. The aims of this study were to determine the association between urinary biomarkers and sepsis in non-AKI critically ill neonates, and to evaluate whether uIL-18 and uCysC could serve as predictors of sepsis in this population.
The study included 111 non-AKI critically ill neonates with acute clinical deterioration suggestive of sepsis: 26 with infection, 57 without infection, and 28 were assigned to the unclassified group. Urinary samples were collected and a full sepsis screen was performed at the time of enrollment.
The level of uIL-18, but not uCysC, was significantly elevated in non-AKI septic neonates. Urinary IL-18 was an independent factor associated with sepsis assessed by multivariate analysis, had odds ratio of 1.73 (95 % CI 1.15 to 2.58, p = 0.008), and achieved the area under the receiver operating characteristic curve of 0.74 for predicting the presence of sepsis in non-AKI critically ill neonates.
Sepsis has an impact on the level of uIL-18, but not on the uCysC in non-AKI neonates, suggesting systemic infection might influence the diagnostic value of uIL-18 to detect AKI in the general population.
KeywordsAcute kidney injury Critically ill neonates C-reactive protein Diagnostic test Urinary biomarkers Urinary cystatin C Urinary interleukin-18 Sepsis
Acute kidney injury
Area under the receiver operating characteristic curve
Neonatal intensive care unit
Receiver operating characteristic
The score for neonatal acute physiology
We thank the staff in biochemistry laboratory for technical assistance. This work was supported by grants from the Science and Technology Program of Suzhou (SYS201137).
- 3.Askenazi DJ, Montesanti A, Hunley H, Koralkar R, Pawar P, Shuaib F, Liwo A, Devarajan P, Ambalavanan N (2012) Urine biomarkers predict acute kidney injury and mortality in very low birth weight infants. J Pediatr 159(907–912):e901Google Scholar
- 23.Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, Pacifico L (2003) C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection. Clin Chem 49:60–68PubMedCrossRefGoogle Scholar
- 35.Stocker M, Hop WC, van Rossum AM (2010) Neonatal Procalcitonin Intervention Study (NeoPInS): effect of Procalcitonin-guided decision making on duration of antibiotic therapy in suspected neonatal early-onset sepsis: A multi-centre randomized superiority and non-inferiority Intervention Study. BMC Pediatr 10:89PubMedCrossRefGoogle Scholar