title: Erythrocyte superoxide dismutase as a biomarker of septic acute kidney injury.
abstract: BACKGROUND
  Oxidative stress is a key feature of sepsis and could be a common pathophysiological pathway between septic shock and acute kidney injury (AKI) Our objective was to evaluate the erythrocyte superoxide dismutase (SOD1) activity as predictor of AKI in patients with septic shock.
  
  
  METHODS
  This is a prospective observational study that evaluated 175 consecutive patients over the age of 18 years with septic shock upon intensive care unit (ICU) admission. However, 43 patients were excluded (27 due to AKI at ICU admission). Thus, 132 patients were enrolled in the study. At the time of the patients' enrollment, demographic information was recorded. Blood samples were taken within the first 24 h of the patient's admission to determine the erythrocyte SOD1 activity. All patients were followed throughout the ICU stay, and the development of AKI was evaluated. In addition, we also evaluated 17 control subjects.
  
  
  RESULTS
  The mean age of patients with septic shock was 63.2 ± 15.7 years, 53 % were male and the median ICU stay was 8 days (4-16). Approximately 50.7 % developed AKI during the ICU stay. The median erythrocyte SOD1 activity was 2.92 (2.19-3.92) U/mg Hb. When compared to control subjects, septic shock patients had a higher serum malondialdehyde concentration and lower erythrocyte SOD1 activity. In univariate analysis, erythrocyte SOD1 activity was lower in patients who developed AKI. The ROC curve analysis revealed that lower erythrocyte SOD1 activity was associated with AKI development (AUC 0.686; CI 95 % 0.595-0.777; p < 0.001) at the cutoff of <3.32 U/mg Hb. In the logistic regression models, SOD1 activity higher than 3.32 U/mg Hb was associated with protection of AKI development when adjusted by hemoglobin, phosphorus and APACHE II score (OR 0.309; CI 95 % 0.137-0.695; p = 0.005) and when adjusted by age, gender, chronic kidney disease, admission category (medical or surgery) and APACHE II score (OR 0.129; CI 95 % 0.033-0.508; p = 0.003).
  
  
  CONCLUSIONS
  In conclusion, our data suggest that erythrocyte SOD1 activity could play a role as an early marker of septic AKI and could be seen as a new research avenue in the field of biomarker in AKI. However, our study did not show a strong correlation between SOD activity and AKI. Nevertheless, these original data do warrant further research in order to confirm or not this hypothesis.
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Nara Aline
authors.initials: NA
authors.lastname: Costa
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Ana Lúcia
authors.initials: AL
authors.lastname: Gut
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Paula Schmidt
authors.initials: PS
authors.lastname: Azevedo
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Suzana Erico
authors.initials: SE
authors.lastname: Tanni
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Natália Baraldi
authors.initials: NB
authors.lastname: Cunha
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Eloá Siqueira
authors.initials: ES
authors.lastname: Magalhães
authors.affiliation: Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Science, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Graziela Biude
authors.initials: GB
authors.lastname: Silva
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Bertha Furlan
authors.initials: BF
authors.lastname: Polegato
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Leonardo Antonio Mamede
authors.initials: LAM
authors.lastname: Zornoff
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Sergio Alberto Rupp
authors.initials: SAR
authors.lastname: de Paiva
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: André Luís
authors.initials: AL
authors.lastname: Balbi
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
authors.affiliation: Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, Botucatu, SP, CEP: 18618-970, Brazil. minicucci@fmb.unesp.br.
authors.forename: Marcos Ferreira
authors.initials: MF
authors.lastname: Minicucci
keywords: Acute kidney injury; Oxidative stress; Sepsis; Superoxide dismutase