The value of serial serum cell adhesion molecules in predicting acute kidney injury after severe sepsis in adults

Background: Septic acute kidney injury (AKI) is a common complication of severe sepsis. We tested the hypothesis that serum cell adhesion molecule levels are substantially increased in early septic AKI and decreased after antimicrobial therapy and their level can predict prognosis. Methods: Seventy-two nontraumatic, nonsurgical adult patients with severe sepsis admitted to the emergency department were evaluated. Serum adhesion molecules were collected and assessed. We evaluated their relationship with early septic AKI compared with other clinical predictors and biomarkers. Results: Forty-five patients (62.5%) experienced early septic AKI. Patients with septic AKI also were more likely to experience septic shock and respiratory failure and had higher in-hospital mortality. Stepwise logistic regression model revealed that E-selectin level, septic shock, and respiratory failure were independently associated with septic AKI and each 1 ng/ml increase in serum E-selectin level increased the risk of septic AKI by 1%. Furthermore, the E-selectin levels in the septic AKI group were significantly higher than those in the non-AKI group at two different times (days 1 and 4). Conclusion: WE show that early septic AKI implies a higher mortality in severe sepsis patients and that E-selectin level at presentation is a powerful predictor of early septic AKI.