RGD Reference Report - Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients. - Rat Genome Database

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Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients.

Authors: Gleeson, Patrick J  Crippa, Ilaria Alice  Mongkolpun, Wasineenart  Cavicchi, Federica Zama  Van Meerhaeghe, Tess  Brimioulle, Serge  Taccone, Fabio Silvio  Vincent, Jean-Louis  Creteur, Jacques 
Citation: Gleeson PJ, etal., Crit Care Med. 2019 Feb;47(2):152-158. doi: 10.1097/CCM.0000000000003544.
RGD ID: 125097479
Pubmed: PMID:30653055   (View Abstract at PubMed)
DOI: DOI:10.1097/CCM.0000000000003544   (Journal Full-text)


OBJECTIVES: To characterize renin in critically ill patients. Renin is fundamental to circulatory homeostasis and could be a useful marker of tissue-perfusion. However, diurnal variation, continuous renal replacement therapy and drug-interference could confound its use in critical care practice.
DESIGN: Prospective observational study.
SETTING: Single-center, mixed medical-surgical ICU in Europe.
PATIENTS: Patients over 18 years old with a baseline estimated glomerular filtration rate greater than 30 mL/min/1.73 m and anticipated ICU stay greater than 24 hours. Informed consent was obtained from the patient or next-of-kin.
INTERVENTIONS: Direct plasma renin was measured in samples drawn 6-hourly from arterial catheters in recumbent patients and from extracorporeal continuous renal replacement therapy circuits. Physiologic variables and use of drugs that act on the renin-angiotensin-aldosterone system were recorded prospectively. Routine lactate measurements were used for comparison.
MEASUREMENTS AND MAIN RESULTS: One-hundred twelve arterial samples (n = 112) were drawn from 20 patients (65% male; mean ± SD, 60 ± 14 yr old) with septic shock (30%), hemorrhagic shock (15%), cardiogenic shock (20%), or no circulatory shock (35%). The ICU mortality rate was 30%. Renin correlated significantly with urine output (repeated-measures correlation coefficient = -0.29; p = 0.015) and mean arterial blood pressure (repeated-measures correlation coefficient = -0.35; p < 0.001). There was no diurnal variation of renin or significant interaction of renin-angiotensin-aldosterone system drugs with renin in this population. Continuous renal replacement therapy renin removal was negligible (mass clearance ± SD 4% ± 4.3%). There was a significant difference in the rate of change of renin over time between survivors and nonsurvivors (-32 ± 26 μU/timepoint vs +92 ± 57 μU/timepoint p = 0.03; mean ± SEM), but not for lactate (-0.14 ± 0.04 mM/timepoint vs +0.15 ± 0.21 mM/timepoint; p = 0.07). Maximum renin achieved significant prognostic value for ICU mortality (receiver operator curve area under the curve 0.80; p = 0.04), whereas maximum lactate did not (receiver operator curve area under the curve, 0.70; p = 0.17).
CONCLUSIONS: In an heterogeneous ICU population, renin measurement was not significantly affected by diurnal variation, continuous renal replacement therapy, or drugs. Renin served as a marker of tissue-perfusion and outperformed lactate as a predictor of ICU mortality.



RGD Manual Disease Annotations    Click to see Annotation Detail View

  
Object SymbolSpeciesTermQualifierEvidenceWithNotesSourceOriginal Reference(s)
RENHumanCritical Illness exacerbatesIEP protein:increased activity:blood plasma (human)RGD 
RenRatCritical Illness exacerbatesISOREN (Homo sapiens)protein:increased activity:blood plasma (human)RGD 
Ren1MouseCritical Illness exacerbatesISOREN (Homo sapiens)protein:increased activity:blood plasma (human)RGD 

Objects Annotated

Genes (Rattus norvegicus)
Ren  (renin)

Genes (Mus musculus)
Ren1  (renin 1 structural)

Genes (Homo sapiens)
REN  (renin)


Additional Information