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Galectin-3 and Soluble CD146 Identify Cardiorenal Injuries in Severe Burn Patients: A Biomarker-Based Approach
Louis Boutin1,2,3, Sabri Soussi4,5, Angèle Garcia Lavello1
1Department of Anaesthesiology, Critical Care Medicine and Burn Unit, AP-HP, Saint-Louis Hospital, DMU Parabol, FHU PROMICE, Université de Paris, Paris, France.
Insights
Cardiorenal syndrome (CRS) is common in severe burn patients. Galectin-3 (Gal3) and soluble CD146 (sCD146) levels can help identify CRS, with their combined use improving prediction accuracy.
Area of Science:
- Biomarker discovery
- Critical care medicine
- Burn injury research
Background:
- Severe burn injuries frequently lead to acute kidney injury (AKI) and myocardial injury (MI).
- The combination of AKI and MI, termed cardiorenal syndrome (CRS), presents a significant clinical challenge.
- Identifying distinct cardiorenal phenotypes is crucial for effective patient management.
Purpose of the Study:
- To assess the occurrence and reliability of Galectin-3 (Gal3) and soluble CD146 (sCD146) as biomarkers for recognizing CRS in severe burn patients.
- To evaluate the predictive performance of these biomarkers in identifying CRS.
Main Methods:
- A single-center prospective proof-of-concept study.
- Plasma samples were collected daily for 7 days post-admission.
- CRS was defined by the presence of AKI (KDIGO stage ≥1) and MI (elevated hsTnT).
Main Results:
- Thirty-eight out of forty patients (95%) developed CRS.
- Gal3 levels, alone or combined with sCD146, were significantly associated with CRS (p < 0.001).
- The combination of Gal3 and sCD146 at admission (D0) showed improved predictive performance for CRS (AUC = 0.81).
- Gal3 levels predicted AKI without MI and MI without AKI, while sCD146 showed poor association with CRS.
Conclusions:
- CRS is a frequent and severe complication in patients with severe burn injuries.
- Gal3 levels during the first week post-admission are associated with CRS.
- Combining Gal3 and sCD146 enhances the prediction of CRS in this patient population.
- Further studies are needed to confirm the utility of these biomarkers for CRS identification.
Introduction:
Acute kidney injury (AKI) and myocardial injury (MI) are severe conditions in patients with severe burn injury, and combination of both is even worst and is called the cardiorenal syndrome (CRS). Identifying a distinct cardiorenal phenotype could significantly enhance the management of these patients. Galectin-3 (Gal3) and soluble CD146 (sCD146) are biomarkers for renal and cardiac injuries. This study aims to assess the occurrence and reliability of these biomarkers in recognizing CRS in individuals who have been severely burn.
Methods:
This study is a single-center prospective proof-of-concept study involving patients with severe burn injuries. Plasma samples for Gal3 and sCD146 measurements were collected daily during the initial 7 days following admission. CRS was defined after 24 h of admission by the association of AKI stage 1 or more (KDIGO definition) and MI defined on high sensitive troponin (hsTnT) (variation >20% baseline value or absolute value >40 ng/mL).
Results:
Forty patients met the inclusion criteria and were included in this study. Thirty-eight patients had CRS. The pooled values of Gal3 or combination of Gal3 and sCD146 values following 7 days after admission were associated with CRS with an odds ratio (OR) of 1.145 (95% CI: 1.081-1.211), p < 0.001, and 1.147 (95% CI: 1.085-1.212), p < 0.001, respectively. Gal3 values at admission (D0) had a predictive performance for CRS with an AUC of 0.78 (95% CI: 0.63-0.93), and this performance improved when using the combination of Gal3 and sCD146 values at admission (D0), with an AUC of 0.81 (95% CI: 0.66-0.96). Gal3 levels during the first 7 days were associated with patients experiencing AKI and no MI, with an OR of 1.129 (95% CI: 1.065-1.195), p < 0.001, and MI without AKI with an OR of 1.095 (95% CI: 1.037-1.167), p < 0.001. sCD146 alone was not associated with AKI without MI or MI without AKI and was poorly associated with CRS.
Conclusion:
In severely burned patients, CRS is a frequent and severe condition. Gal3 values during the first 7 days following admission were associated with CRS. The use of sCD146 with Gal3 improved prediction performance for CRS identification. The use of such biomarkers to identify CRS is important and needs to be confirmed in other studies.
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