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Master's Dissertation
DOI
10.11606/D.7.2004.tde-16112006-114934
Document
Author
Full name
Cristina Satoko Mizoi Hokama
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2004
Supervisor
Committee
Vattimo, Maria de Fatima Fernandes (President)
Peniche, Aparecida de Cassia Giani
Santos, Oscar Fernando Pavao dos
Title in Portuguese
Função renal de pacientes de Unidade de Terapia Intensiva: creatinina plasmática e proteína carreadora do retinol urinário (RBPu).
Keywords in Portuguese
Creatinina plasmática
Proteína carreadora do retinol
Unidade de terapia intensiva
Abstract in Portuguese
A avaliação da disfunção renal pelos marcadores usuais não tem determinado impacto na redução da incidência da insuficiência renal aguda (IRA) nos pacientes de terapia intensiva. Este estudo avaliou 100 pacientes admitidos em uma unidade de terapia intensiva (UTI) quanto às características demográficas; a relação entre creatinina plasmática e proteína carreadora do retinol (RBPu) e as variáveis clínico-laboratoriais; e a sensibilidade e a especificidade da RBPu. A amostra caracterizou-se como geriátrica (63,4±15,6 anos), do sexo masculino (68%), 47% dos pacientes tiveram tratamento clínico e 53% cirúrgico. A coleta de dados foi realizada no período de 13,9±8,3 horas após a admissão na UTI. A análise dos resultados mostrou associação entre a creatinina plasmática e as variáveis: gênero (p-0,026), idade (p-0,038), uso de droga vasoativa (p-0,003), proteínúria (p-0,025), APACHE II (p-0,000), uréia (p-0,000), potássio (p-0,003) e clearance de creatinina estimado (p-0,000). A RBPu mostrou associação com um número maior de variáveis: peso (IMC), uso de ventilação invasiva (p-0,000), uso de antiinflamatório não-hormonal (p-0,018), uso de droga vasoativa (p-0,021), temperatura > 37,5ºC (p-0,005), proteinúria (p-0,000), bilirrubinúria (p-0,004), fluxo urinário (p-0,019), pressão arterial diastólica mínima (p-0,032), pressão arterial sistólica mínima (p-0,029), APACHE II (p-0,000), creatinina (p-0,001), uréia (p-0,001), clearance de creatinina estimado (p-0,000) e uma tendência a associação com os antecedentes clínicos (doença renal, vasculopatia e neoplasia). A creatinina plasmática e a RBPu apresentaram associação com a fração de excreção de sódio (FENa) quando os dados foram submetidos à análise univariada. O estudo referente à sensibilidade e especificidade da RBPu utilizando a curva ROC (Relative Operating Characteristics) mostrou que pacientes com RBPu maior que 1,47 mg/l têm aproximadamente quatro chances de apresentarem creatinina acima de 1,2 mg/dl (intervalo de confiança - 95%, erro padrão - 0,072). A acurácia global da RBPu, como teste diagnóstico, foi fraca. A RBPu, apesar das fracas sensibilidade e especificidade encontradas no estudo, pode ser considerada na clínica, o marcador de melhor desempenho diagnóstico em pacientes com risco para a ocorrência de IRA quando comparada aos marcadores utilizados rotineiramente.
Title in English
Renal function of intensive care unit patients: plasma creatinine and urinary retinol-binding protein (uRBP).
Keywords in English
Intensive care unit
Plasma creatinine
Retinol-binding protein
Abstract in English
The early assessment of renal dysfunction using common markers has not determined an impact on lower incidence of acute renal failure (ARF) in intensive care patients, which remains alarming high. This study followed-up 100 patients admitted to an intensive care unit (ICU) and assessed demographic variables as well as plasma creatinine and urinary retinol-binding protein (uRBP) ratio with clinical and laboratory variables within the first hours of admission to the ICU. The sample was characterized as geriatric (63.4±15.6 years), male (68%), 47% clinical and 53% surgical patients. Data were gathered 13.9±8.3 hours after admission to ICU. Statistical analysis showed association between plasma creatinine and the following variables: gender (p-0.026), age (p-0.038), use of vasoactive drugs (p-0.003), proteinuria (p-0.025), APACHE II (p-0.000), urea (p-0.000), potassium (p-0.003) and estimated creatinine clearance (p-0.000). uRBP correlated with more variables: weight (BMI), use of invasive ventilation (p-0.000), use of nonsteroidal anti-inflammatory drugs (p-0.018), use of vasoactive drugs (p-0.021), temperature > 37.5ºC (p-0.005), proteinuria (p-0.000), bilirubinuria (p-0.004), urinary flow (p-0.019), minimal diastolic pressure (p-0.032), minimal systolic pressure (p-0.029), APACHE II (p-0.000), creatinine (p-0.001), urea (p-0.001), estimated creatinine clearance (p-0.000). uRBP also tended to associate with clinical past medical history (renal disease, vasculopathy and neoplasm). FENa correlated with plasma creatinine and uRBP in univariate analysis. The ROC (Receiver Operating Characteristic) curve demonstrated that patients with uRBP > 1.47 mg/l are four times more likely to have creatinine > 1.2 mg/dl (95% confidence interval, standard error, 0.072). The global accuracy of uRBP as a diagnostic test was poor. Although uRBP sensibility and specificity were not very high in the study, in clinical practice it might be considered the better marker regarding diagnostic performance in patients at risk of developing ARF, as compared with other markers routinely used. Moreover, uRBP has other features of a good diagnostic test - it is a practical and non-invasive method, and its cost may drop as the test becomes more frequently requested.
 
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Publishing Date
2006-11-17
 
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