Hypoalbuminemia as a predictor of acute kidney injury during colistin treatment

This study aimed to assess the predictors of acute kidney injury (AKI) during colistin therapy in a cohort of patients with bloodstream infections (BSI) due to colistin-susceptible Gram-negative bacteria, focusing on the role of serum albumin levels. The study consisted of two parts: (1) a multicent...

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Published in:	Scientific reports Vol. 8; no. 1; pp. 11968 - 11
Main Authors:	Giacobbe, Daniele Roberto, di Masi, Alessandra, Leboffe, Loris, Del Bono, Valerio, Rossi, Marianna, Cappiello, Dario, Coppo, Erika, Marchese, Anna, Casulli, Annarita, Signori, Alessio, Novelli, Andrea, Perrone, Katja, Principe, Luigi, Bandera, Alessandra, Vender, Luca Enrico, Misin, Andrea, Occhilupo, Pierpaolo, Melone, Marcello, Ascenzi, Paolo, Gori, Andrea, Luzzati, Roberto, Viscoli, Claudio, Di Bella, Stefano
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 10-08-2018 Nature Publishing Group
Subjects:	692/499 692/699/255/1318 Albumin Bacteria Colistin Gram-negative bacteria Human serum albumin Humanities and Social Sciences Kidneys multidisciplinary Patients Science Science (multidisciplinary)
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Summary:	This study aimed to assess the predictors of acute kidney injury (AKI) during colistin therapy in a cohort of patients with bloodstream infections (BSI) due to colistin-susceptible Gram-negative bacteria, focusing on the role of serum albumin levels. The study consisted of two parts: (1) a multicentre retrospective clinical study to assess the predictors of AKI during colistin therapy, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria; and (2) bioinformatic and biochemical characterization of the possible interaction between human serum albumin and colistin. Among the 170 patients included in the study, 71 (42%), 35 (21%), and 11 (6%) developed KDIGO stage 1 (K1-AKI), KDIGO stage 2 (K2-AKI), and KDIGO stage 3 (K3-AKI), respectively. In multivariable analyses, serum albumin <2.5 g/dL was independently associated with K1-AKI (subdistribution hazard ratio [sHR] 1.85, 95% confidence interval [CI] 1.17–2.93, p = 0.009) and K2-AKI (sHR 2.37, 95% CI 1.15–4.87, p = 0.019). Bioinformatic and biochemical analyses provided additional information nurturing the discussion on how hypoalbuminemia favors development of AKI during colistin therapy. In conclusion, severe hypoalbuminemia independently predicted AKI during colistin therapy in a large cohort of patients with BSI due to colistin-susceptible Gram-negative bacteria. Further study is needed to clarify the underlying causal pathways.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2045-2322 2045-2322
DOI:	10.1038/s41598-018-30361-5