Immune profiling of critically ill patients with acute kidney injury during the first week after various types of injuries: the REALAKI study
Rattachement africain : fr, us. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Abstract Background Acute kidney injury (AKI) is common in hospitalized patients and results in significant morbidity and mortality. The objective of the study was to explore the systemic immune response of intensive care unit patients presenting with AKI, especially the association between immune profiles and persistent AKI during the first week after admission following various types of injuries (sepsis, trauma, surgery, and burns). Methods REALAKI is an ancillary analysis of the REAnimation Low Immune Status Marker (REALISM) cohort study, in which 359 critically ill patients were enrolled in three different intensive care units. Patients with end-stage renal disease were excluded from the REALAKI study. Clinical samples and data were collected three times after admission: at day 1 or 2 (D1-2), day 3 or 4 (D3-4) and day 5, 6 or 7 (D5-7). Immune profiles were compared between patients presenting with or without AKI. Patients with AKI at both D1-2 and D5-7 were defined as persistent AKI. A multivariable logistic regression model was performed to determine the independent association between AKI and patients’ immunological parameters. Results Three hundred and fifty-nine patients were included in this analysis. Among them, 137 (38%) were trauma patients, 103 (29%) post-surgery patients, 95 (26%) sepsis patients, and 24 (7%) were burn patients. One hundred and thirty-nine (39%) patients presented with AKI at D1-2 and 61 (20%) at D5-7. Overall, 94% presented with persistent AKI at D5-7. Patients with AKI presented with increased pro and anti-inflammatory cytokines and altered innate and adaptive immune responses. The modifications observed in the immune profiles tended to be more pronounced with increasing KDIGO stages. In the logistic regression model, a statistically significant association was observed at D1-2 between AKI and CD10 low CD16 low immature neutrophils (OR 3.03 [1.7–5.5]— p < 0.001). At D5-7, increased interleukin-10 (IL-10) levels and reduced ex vivo TNF-α production after LPS stimulation were significantly associated with the presence of AKI (OR 1.38 [1.12–1.71]— p = 0.001 and 0.51 [0.27–0.91]— p = 0.03, respectively). Patients who recovered from AKI between D1-2 and D5-7 compared to patients with persistent AKI at D5-7, tended to correct these alterations. Conclusion Following various types of severe injuries, early AKI is associated with the initial inflammatory response. Presence of AKI at the end of the first week after injury is associated with injury-induced immunosuppression.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Immune profiling of critically ill patients with acute kidney injury during the first week after various types of injuries: the REALAKI study
- Date Crossref
- 08/07/2024
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Lyon 1 Université pays non établi dans la noticeUniversité ou école supérieure
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Lyon College pays non établi dans la noticeUniversité ou école supérieure
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Hospices Civils de Lyon pays non établi dans la noticeÉtablissement de santé
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Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques pays non établi dans la noticeStructure de recherche
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bioMérieux (France) pays non établi dans la noticeEntreprise
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École Normale Supérieure de Lyon pays non établi dans la noticeUniversité ou école supérieure
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Centre National de la Recherche Scientifique pays non établi dans la noticeOrganisme public
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Inserm pays non établi dans la noticeOrganisme public
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Centre International de Recherche en Infectiologie pays non établi dans la noticeStructure de recherche
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Edouard Herriot Hospital Anesthesia and Critical Care Medicine Department pays non établi dans la noticeÉtablissement de santé
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Immunology Laboratory pays non établi dans la noticeStructure de recherche
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Claude Bernard University Lyon 1 CNRS pays non établi dans la noticeUniversité ou école supérieure
Lyon 1 Université, Lyon College et Hospices Civils de Lyon, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.