Abstract
Background: Sepsis is a leading cause of increased morbidity and mortality rates in hospitalized patients and is the most common cause of acute kidney injury (AKI). A potential biomarker that can predict the occurrence of AKI in septic patients is proenkephalin (PENK), an endogenous precursor of opioids.
Methods: This prospective cohort study included 40 septic patients at Wahidin Sudirohusodo Hospital, Makassar, from March to May 2024. Plasma levels of PENK were measured using the enzyme-linked immunosorbent assay (ELISA) method. Data were analyzed statistically using the Shapiro-Wilk, Mann-Whitney, Wilcoxon, and Spearman correlation tests.
Results: The study included 23 men (57.5%) and 17 women (42.5%). Patients predominantly required ventilators as respiratory aids (35%). The average length of stay was 23.5 days. The mean Sequential Organ Failure Assessment (SOFA) score was 5.03±2.6. The mean procalcitonin level was 38.6±56.2, with a range of 0.12-249.26. The mean PENK level on day 7 was lower (294.67 pg/ml) than the initial level (402.02 pg/ml) in septic patients who did not experience AKI. In septic patients who experienced AKI, the mean PENK level on day 7 was higher (421.56 pg/ml) than the initial level (191.78 pg/ml). A plasma PENK level >194.65 pg/ml can indicate AKI in adult septic patients with a sensitivity of 62.5% and a specificity of 82.25%, with a positive likelihood ratio of 3.33.
Conclusion: There was a significant difference between the initial PENK levels and the PENK levels on day 7 in septic patients who did not experience AKI and those who did. Plasma PENK levels in septic patients could be used as a predictive marker for the likelihood of acute kidney injury.
Diana Tangdan Ampulembang, Fitriani Mangarengi, Yuyun Widaningsih, Ilham Jaya Patellongi, Faisal Muchtar, Nursin Abd Kadir
