The severity of acute renal injury as a prognosis of acute peritonitis

Abstract

Background. The success of urgent abdominal diseases treatment is ensured by the impact on the pathogenetic links of the process and the restoration of the activity of organs subjected to inflammatory changes. The development of acute renal injury in patients with acute peritonitis determines the course and outcome of the underlying surgical disease. For this reason, the development of a method for determining the risk of developing acute kidney injury using components of lipid metabolism in patients with acute peritonitis is the aim of this study. Materials and methods. The study included 26 patients with various surgical diseases, against which the development of acute peritonitis and acute renal injury was noted. The dynamics (days 1, 3, and 5 of observation) of lysophospholipids, sphingomyelin, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, phosphatidylethanolamine, total phospholipids, monoacylglycerol, cholesterol, diacylglycerol, free fatty acids, triacylglycerol, cholesterol esters were studied. Statistical analysis was performed using the SPSS Statistica 16.0 program. The main components of lipid metabolism, which have the maximum informative value, taken as the basis of the model of acute kidney injury, have been identified. Results. A step-by-step analysis of the data made it possible to form a group of criteria (monoacyl-glycerol, phosphatidyl-inositol, phosphatidyl-serine, cholesterol) that have a diagnostic capability in the prognosis of acute kidney injury in surgical patients. To build a prognostic formula by analysis of variance, the following coefficients were derived: –0.438 for monoacyl glycerol (p = 0.05); 0.189 for phosphatidyl-inositol (p = 0.03); 0.193 for phosphatidylserine (p = 0.001); –0.116 for cholesterol (p = 0.001). Conclusions. The conducted studies demonstrate that lipid metabolism indicators reflect the presence and degree of destruction of cell membranes. The use of statistical data processing methods made it possible to form a group of indicative criteria reflecting the activity of inflammatory- destructive membrane-forming components. On their basis, a model describing the risk of developing acute renal injury was created with high reliability. The final value of the listed criteria, equal to 3.5 or more, reflects a high risk of developing acute kidney injury.

Keywords

• acute kidney injury
• acute peritonitis
• disease prognosis