[HTML][HTML] Angiopoietin-2 in patients requiring renal replacement therapy in the ICU: relation to acute kidney injury, multiple organ dysfunction syndrome and outcome
Intensive care medicine, 2010•Springer
Purpose Endothelial activation has emerged as an early event in the pathogenesis of
microcirculatory dysfunction, capillary leakage and multi-organ dysfunction syndrome
(MODS). Angiopoietin-2 (Ang-2), a circulating antagonistic ligand of the endothelial-specific
Tie2 receptor, has been identified as a non-redundant gatekeeper of endothelial activation.
On the basis of our previous report demonstrating release of Ang-2 in endotoxemia and
sepsis, we aimed to study the utility of Ang-2 to serve as an outcome-specific biomarker in …
microcirculatory dysfunction, capillary leakage and multi-organ dysfunction syndrome
(MODS). Angiopoietin-2 (Ang-2), a circulating antagonistic ligand of the endothelial-specific
Tie2 receptor, has been identified as a non-redundant gatekeeper of endothelial activation.
On the basis of our previous report demonstrating release of Ang-2 in endotoxemia and
sepsis, we aimed to study the utility of Ang-2 to serve as an outcome-specific biomarker in …
Purpose
Endothelial activation has emerged as an early event in the pathogenesis of microcirculatory dysfunction, capillary leakage and multi-organ dysfunction syndrome (MODS). Angiopoietin-2 (Ang-2), a circulating antagonistic ligand of the endothelial-specific Tie2 receptor, has been identified as a non-redundant gatekeeper of endothelial activation. On the basis of our previous report demonstrating release of Ang-2 in endotoxemia and sepsis, we aimed to study the utility of Ang-2 to serve as an outcome-specific biomarker in patients requiring renal replacement therapy (RRT) in the intensive care unit (ICU).
Methods
We measured circulating Ang-2 by ELISA in 117 critically ill patients with AKI at inception of RRT in the ICU. Mortality, length of stay and renal recovery were prospectively assessed during a study period of 28 days after the inception of RRT.
Results
Circulating Ang-2 levels were significantly higher in AKI patients with RIFLE category-Injury or -Failure, compared to patients with RIFLE category-Risk. Elevated levels of circulating Ang-2 correlated with impaired oxygenation, low mean arterial pressure, vasopressor dose and the sequential organ failure assessment (SOFA) score. Ang-2 concentrations were significantly higher in non-survivors than in survivors at day 0 and day 14 after initiation of RRT. Multivariate Cox regression and decision tree analyses confirmed a strong independent prognostic impact of elevated Ang-2 as a predictor of 28-day survival.
Conclusions
The results from this study indicate that circulating Ang-2 is as a strong and independent predictor of mortality in ICU patients with dialysis-dependent AKI.
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