Key result
Elevated serum renin linked to higher mortality in critically ill and perioperative patients.
Why the study?
Serum renin levels have been reported to associate with adverse clinical outcomes in acute care settings, but a comprehensive review of their prognostic value in intensive care and perioperative patients was lacking.
Are elevated serum renin levels associated with mortality and adverse outcomes in intensive care and perioperative patients?
Systematic Review (n=1,573)
Are elevated serum renin levels associated with mortality and adverse outcomes in intensive care and perioperative patients?
Elevated serum renin levels are associated with poor clinical outcomes, including mortality, in critically ill and perioperative patients, and may identify those who benefit from synthetic angiotensin II.
Serum renin may aid prognostication in acute care; leaves open validation and cardiovascular-specific applications.
Serum renin increases in response to sympathetic nerve activation and hypotension. Recent studies have reported the association of serum renin levels with adverse clinical outcomes in acute care settings. This scoping review aimed to systematically review the available literature on renin as a prognostic marker in intensive care and perioperative patients. We searched for studies published since inception until March 31, 2023, which assessed the association between serum renin levels and clinical outcomes or the effect of synthetic angiotensin II administration on serum renin levels in critically ill and perioperative patients in PubMed, Embase, and the Cochrane Library. The primary outcome was mortality at the longest follow-up; the secondary outcomes were adverse renal outcomes (ie, acute kidney injury, the need for renal replacement therapy, and major adverse kidney events), hemodynamic instability, outcomes to angiotensin II administration, and prognostic performance for mortality when compared with lactate. Among the 2081 studies identified, we included 16 studies with 1573 patients (7 studies on shock, 5 on nonspecific critical illness, 2 on cardiac surgery, 1 on noncardiac surgery, and 1 on coronavirus disease 2019). A significant association between serum renin levels and poor outcomes was identified in 14 studies, with 10 studies demonstrating an association with mortality. One post hoc analysis found that angiotensin II administration reduced mortality in patients with markedly elevated renin values. Two studies showed that renin was superior to lactate as a prognostic marker of mortality. Our scoping review showed that elevated serum renin levels may be associated with clinically relevant outcomes among various perioperative and intensive care populations. Increased serum renin levels may identify patients in which synthetic angiotensin II administration improves clinical outcomes and may outperform serum lactate in predicting mortality.
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Kotani et al. (2023) conducted a systematic review in Critically ill and perioperative patients (n=1,573). Elevated serum renin levels was evaluated on Mortality at the longest follow-up. Elevated serum renin levels were significantly associated with poor outcomes in 14 of 16 studies, including mortality in 10 studies, among critically ill and perioperative patients.
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