As recently been developed and consists of cell cycle markers, like
As recently been developed and consists of cell cycle markers, like urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin like growth factor-binding protein 7 (IGFBP-7). Probably the most promising application of these biomarkers in oncology is their potential for early detection of nephrotoxicity by antineoplastic agents during their development phase and in preclinical studies. Some studies [23, 24] have demonstrated that the presence of antineoplastic nephrotoxicity was associated with an increase in AKI biomarkers. Two commercially available AKI biomarkers NGAL and [TIMP-2] IGFBP7] can be measured on standard platforms used for routine biochemistry or with a pointof-care device. Recent findings, however, challenge the PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28461585 robustness and utility of cell cycle arrest biomarkers for the prediction of AKI in general ICU patients with heterogeneous diagnoses, differing comorbidities, and multiple sources of inflammation [25]. In particular, the association with inflammation may obscure the picture in cancer patients. There are at present no studies that have evaluatedLameire et al. Critical Care (2016) 20:Page 3 ofwhether earlier diagnosis of AKI by these biomarkers indeed results in better patient outcomes, and consequently in decreased costs [26].Patients with cancer and AKI A substantial rise in AKI has been noted worldwide [27] and in the subgroup of noncritically ill and critically ill patients with cancer [28, 29]. Cancer patients represent about 20 of ICU admissions [30, 31]. In a recent multinational study, an even distribution in cancer patients was observed between the subgroup without (18.8 ) vs with (20.5 ) AKI [30]. As in many other AKI populations, even small increases of SCr (0.2 mg/dl?7.6 mol/l), previously considered trivial, are associated with prolonged ICU stay and increased mortality [32], and this is independent from severity of illness or other risk factors. In the Dutch National Intensive Care Evaluation (NICE) database [33] AKI occurred in 19.4 of hematological patients admitted to the ICU, which is comparable with incidence rates in patients with chronic liver cirrhosis and chronic heart failure, but higher than in patients with solid tumors (11 ). Overall prognosis of critically ill cancer patients The overall prognosis of patients with cancer is strongly dependent on the type of ICU admission and underlying cancer. In a cohort including 1257 patients with cancer, in those admitted to the ICU (404, 32.1 ) overall ICU and hospital mortalities were 20.8 and 28.6 , respectively [34]. As expected, hospital mortality was 4-HydroxytamoxifenMedChemExpress (Z)-4-Hydroxytamoxifen significantly higher for medical (69.4 ) and emergency surgical patients (49.3 ) than for scheduled surgical patients (5.7 ; p < 0.001). After exclusion of scheduled surgical patients, those with solid tumors had a lower mortality compared with those with hematological malignancies (56.0 and 67.2 , p = 0.030). Of the 3147 patients enrolled in the SOAP study, 473 (15 ) had a malignancy, 404 (85 ) solid cancer, and 69 (15 ) hematological cancer [35]. Patients with solid cancers had a similar severity of illness compared with the noncancer population, but cancer patients were older and were more likely to be admitted after surgery. Patients with hematological malignancies were the most severely ill and more commonly suffered from sepsis, acute lung injury/acute respiratory distress syndrome, and renal failure than patients with other malignancies; these patients also had.