Impact of red cell hemolysis in patientwith sepsis on patient outcome & occurrence of acute kidney injury / Samy Mahmoud Samy ; Supervised Akram Mohamed Abdelbary , Mohamed M.Youssif Khaled , Nadia Ibrahim Sewelam

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Introduction: Sepsis is one of the most important causes of death in ICU, Acute kidney injury is one of MODS that occur in sepsis. Sepsis can alter RBCS morphology & rheology (viscosity, aggregation and deformability) which cause hemolysis. Aim of the study :Evaluate haptoglobin, free hemoglobin and NGAL in estimation of morbidity, mortality and AKI in sepsis; sever sepsis and septic shock patients with normal kidney function on admissionwith APACHE II score and SOFA score. Methodology:We included 44 patient admitted to ICU with sepsis and septic shock with normal kidney function on admission,(Full laboratories), (blood, urine, sputum and drains c/s) (blood sample for haptoglobin, NGAL and free hemoglobin). Results: Haptoglobin day1 statistically correlated with GCS (R: 0.341, P: 0.024), NGAL day 1, APACHE II and SOFA day1 (R: -0.623, -0.679, -0.745, P < 0.001, < 0.001, < 0.001) respectively. Free hemoglobin day1 statistically correlated with GCS (R: - 0.0455, p: 0.002), NGAL day1, APACHE II, SOFA day1and haptoglobin day 1 (R: 0.571, 0.556, 0.693,-0.668 P:< 0.001, < 0.001, 0.001, <0.001) respectively. NGAL values on day 1 statistically correlated to GCS (R: - 0.402 P: 0.007) APACHE II, SOFA on admission and SOFA on day 1 (R: 0.717, 0.749, 0.756) (P :< 0.001, < 0.001, < 0.001) respectively. Mortality was statistically significant correlated to Haptoglobin (P:< 0.001) (R: -0.0762), free hemoglobin (P < 0.001 R: 0.780) and NGAL (P :< 0.001)(R:0.768). NGAL had AUC of 69.9% with sensitivity of 72.4% and specificity of 60.0% for cut-off of 117 ng/ml at day 1 to predict AKI.

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