Baseline Serum Estradiol Level Is Associated with Acute Kidney Injury in Patients with Moderately Severe and Severe Acute Pancreatitis

Overview

Journal Gastroenterol Res Pract

Publisher Wiley

Specialty Gastroenterology

Date 2022 Jul 7

PMID 35795381

Authors

Jia-Jia Pan

Wei-Li Liu

Guo-Tao Lu

Xing-Jie Ma

Qing-Bin Zheng

Guang-Fa Wei

Ge-Yan Tian

Li-Jun Meng

Affiliations

Soon will be listed here.

Abstract

Background: Sexual dimorphism with critical diseases has been documented. However, the role of serum sex hormones for the presence of acute kidney injury (AKI) in moderately or severe acute pancreatitis (MSAP and SAP) patients remains controversial. Here we set out to evaluate whether early (first 48 h) serum estradiol level is associated with AKI in patients with MSAP and SAP. . We retrospectively collected data from patients with preliminary diagnosis of MSAP and SAP from the Affiliated Hospital of Yangzhou University between January 2014 and June 2018. Serum sex hormones were extracted for further assessment within first 48 h following admission. Logistic regression analysis and the receiving operating characteristic (ROC) curve were applied to evaluate the association and correlation between serum sex hormones and AKI.

Results: Data from a total of 122 patients with MSAP or SAP were enrolled in this study. There were no differences in the incidence of AKI between males and females. However, comparing with patients without AKI, those with AKI saw higher estradiol level ( ≤ 0.01) and slight higher progesterone level ( = 0.014) but similar testosterone level ( = 0.668). Interestingly, during both the manual selection and the stepwise backward logistic regression analysis, serum estradiol level was independently associated with AKI in patients with MSAP and SAP (OR 4.699, CI 1.783-12.386, and = 0.002). Additionally, area under the curve of ROC (AUCROC) showed that serum estradiol level was a proper predictor for AKI (area under the curve 0.875). Specifically, the serum estradiol level of 223.15 pg/mL demonstrated a 92.3% sensitive and a 79.3% specificity in predicting AKI of MSAP and SAP patients, respectively.

Conclusions: High baseline serum estradiol level appears to be an independent risk factor for AKI in patients with MSAP and SAP. It also tends to be an appropriate indicator for AKI.

References

Wu C, Chang C, Chang S, Chen S . 17β-Estradiol Accelerated Renal Tubule Regeneration in Male Rats After Ischemia/Reperfusion-Induced Acute Kidney Injury. Shock. 2016; 46(2):158-63. DOI: 10.1097/SHK.0000000000000586. View

Papathanassoglou E, Middleton N, Benbenishty J, Williams G, Christofi M, Hegadoren K . Systematic review of gender- dependent outcomes in sepsis. Nurs Crit Care. 2017; 22(5):284-292. DOI: 10.1111/nicc.12280. View

Kellum J, Lameire N . Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17(1):204. PMC: 4057151. DOI: 10.1186/cc11454. View

Kosyreva A . The Sex Differences of Morphology and Immunology of SIRS of Newborn Wistar Rats. Int Sch Res Notices. 2016; 2014:190749. PMC: 4897487. DOI: 10.1155/2014/190749. View

Li M, Yu J, Zhao L, Mei F, Zhou Y, Hong Y . Inhibition of macrophage migration inhibitory factor attenuates inflammation and fetal kidney injury in a rat model of acute pancreatitis in pregnancy. Int Immunopharmacol. 2019; 68:106-114. DOI: 10.1016/j.intimp.2018.12.068. View

Pisera D, Candolfi M, Navarra S, Ferraris J, Zaldivar V, Jaita G . Estrogens sensitize anterior pituitary gland to apoptosis. Am J Physiol Endocrinol Metab. 2004; 287(4):E767-71. DOI: 10.1152/ajpendo.00052.2004. View

Lankisch P, Assmus C, Lehnick D, Maisonneuve P, Lowenfels A . Acute pancreatitis: does gender matter?. Dig Dis Sci. 2001; 46(11):2470-4. DOI: 10.1023/a:1012332121574. View

Stirling A, Moran N, Kelly M, Ridgway P, Conlon K . The predictive value of C-reactive protein (CRP) in acute pancreatitis - is interval change in CRP an additional indicator of severity?. HPB (Oxford). 2017; 19(10):874-880. DOI: 10.1016/j.hpb.2017.06.001. View

Sarr M . 2012 revision of the Atlanta classification of acute pancreatitis. Pol Arch Med Wewn. 2013; 123(3):118-24. DOI: 10.20452/pamw.1627. View

10.

Marshall J, Cook D, Christou N, Bernard G, Sprung C, Sibbald W . Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995; 23(10):1638-52. DOI: 10.1097/00003246-199510000-00007. View

11.

Giannoni E, Guignard L, Reymond M, Perreau M, Roth-Kleiner M, Calandra T . Estradiol and progesterone strongly inhibit the innate immune response of mononuclear cells in newborns. Infect Immun. 2011; 79(7):2690-8. PMC: 3191988. DOI: 10.1128/IAI.00076-11. View

12.

OBrien Z, Cass A, Cole L, Finfer S, Gallagher M, McArthur C . Sex and mortality in septic severe acute kidney injury. J Crit Care. 2018; 49:70-76. DOI: 10.1016/j.jcrc.2018.10.017. View

13.

Angele M, Pratschke S, Hubbard W, Chaudry I . Gender differences in sepsis: cardiovascular and immunological aspects. Virulence. 2013; 5(1):12-9. PMC: 3916365. DOI: 10.4161/viru.26982. View

14.

Bernard G, Vincent J, Laterre P, LaRosa S, Dhainaut J, Lopez-Rodriguez A . Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001; 344(10):699-709. DOI: 10.1056/NEJM200103083441001. View

15.

Lankisch P, Apte M, Banks P . Acute pancreatitis. Lancet. 2015; 386(9988):85-96. DOI: 10.1016/S0140-6736(14)60649-8. View

16.

Feng J, Liu K, Abraham E, Chen C, Tsai P, Chen Y . Serum estradiol levels predict survival and acute kidney injury in patients with septic shock--a prospective study. PLoS One. 2014; 9(6):e97967. PMC: 4048195. DOI: 10.1371/journal.pone.0097967. View

17.

Tenner S, Baillie J, DeWitt J, Vege S . American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013; 108(9):1400-15. DOI: 10.1038/ajg.2013.218. View

18.

Kusnierz-Cabala B, Gala-Bladzinska A, Mazur-Laskowska M, Dumnicka P, Sporek M, Matuszyk A . Serum Uromodulin Levels in Prediction of Acute Kidney Injury in the Early Phase of Acute Pancreatitis. Molecules. 2017; 22(6). PMC: 6152627. DOI: 10.3390/molecules22060988. View

19.

Hutchens M, Fujiyoshi T, Komers R, Herson P, Anderson S . Estrogen protects renal endothelial barrier function from ischemia-reperfusion in vitro and in vivo. Am J Physiol Renal Physiol. 2012; 303(3):F377-85. PMC: 3774263. DOI: 10.1152/ajprenal.00354.2011. View

20.

Tran D, Oe P, de Fijter C, van der Meulen J, Cuesta M . Acute renal failure in patients with acute pancreatitis: prevalence, risk factors, and outcome. Nephrol Dial Transplant. 1993; 8(10):1079-84. View