• Camila Barbosa Araújo, de Oliveira Neves Fernanda Macedo FM Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil., Daniele Ferreira de Freitas, Bianca Fernandes Távora Arruda, de Macêdo Filho Leonardo José Monteiro LJM Medical Course, Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil., Vivian Brito Salles, Gdayllon Cavalcante Meneses, Martins Alice Maria Costa AMC Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceará, Fortaleza, Brazil., and Alexandre Braga Libório.
• Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Brazil.
• Respirology. 2019 Apr 1; 24 (4): 345-351.

Background And ObjectiveAngiopoietin-2 (AGPT2) has been proposed as a key mediator of organ dysfunction, mainly in acute respiratory distress syndrome (ARDS). It has also been associated with acute kidney injury (AKI). We aimed to investigate the role of AGPT2 in patients with and without ARDS.MethodsIn a cohort study with critically ill patients, AGPT1 and AGPT2 were assayed in plasma collected within the first 24 h after admission to intensive care unit (ICU). Severe AKI and the need for dialysis were outcome measures from comparative analysis with clinical characteristics useful for AKI risk stratification.ResultsAmong 283 patients (50.2% males), 109 (38.5%) had ARDS. AGPT2 levels at admission were higher in patients with ARDS. Although overall AGPT2 and AGPT2/AGPT1 levels were associated with severe AKI, this association was not significant in patients without ARDS; however, it remained strongly significant in ARDS patients. In patients without ARDS, AGPT2 showed only a weak discriminatory capacity to predict severe AKI (area under the curve (AUC): 0.64 vs 0.81 in the ARDS group). The continuous net reclassification improvement (NRI) in the ARDS group resulting from AGPT2 inclusion was 64.1% (P < 0.001) and the integrated discrimination improvement (IDI) index was 0.057 (P = 0.003). There was no significant difference in NRI in the no-ARDS group.ConclusionAGPT2 and AGPT2/AGPT1 ratio are associated with severe AKI and there was only a need of renal replacement therapy (RRT) in patients with or at risk of ARDS, not in other critically ill patients. Adding AGPT2 to a clinical model resulted in a significant improvement in the capacity to predict severe AKI specifically in ARDS patients.© 2019 Asian Pacific Society of Respirology.

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