Early detection and risk stratification of sepsis & sepsis-associated acute kidney injury
Early detection and risk stratification of sepsis & sepsis-associated acute kidney injury
This thesis of Tamar van der Aart explores strategies to improve the early recognition of sepsis and sepsis-associated acute kidney injury (SA-AKI) in the emergency department (ED). Sepsis is a life-threatening condition in which a dysregulated response to infection can lead to organ dysfunction, including kidney injury. Early recognition is essential but remains challenging in clinical practice due to the highly variable presentation of sepsis.
This thesis investigates strategies to improve the early and more accurate identification of sepsis and SA-AKI. Clinical scoring systems are currently used for this purpose. Several existing scoring systems were evaluated for their suitability in the ED. The predictive value of urinary biomarkers for kidney-specific outcomes was assessed. Additionally, novel biomarkers, including volatile organic compounds in exhaled breath (VOCs), microRNAs, and circulating proteins, were evaluated for their potential to detect disease processes early.
The results show that the practical NEWS score is the most suitable tool for the objective identification of sepsis in the ED. Existing urinary biomarkers were not able to accurately predict kidney-specific outcomes. In contrast, VOCs appear to hold potential for bedside recognition of sepsis in the ED, and certain proteins and microRNAs showed promising potential for the identification of SA-AKI.
This thesis therefore highlights both the potential and the limitations of current diagnostic and prognostic strategies and underscores the need for a better understanding of the underlying biological mechanisms of sepsis and SA-AKI.