• Lui G Forni, Michael Joannidis, Antonio Artigas, Max Bell, Eric Hoste, Olivier Joannes-Boyau, Kianoush Kashani, Jay Koyner, Thomas Rimmele, Jing Shi, Marlies Ostermann, Lakhmir S Chawla, John A Kellum, and Sapphire Investigators.
• Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey and Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK. Electronic address: luiforni@nhs.net.
• J Crit Care. 2022 Oct 1; 71: 154066154066.

PurposeAlthough epidemiological studies have enhanced our understanding of acute kidney injury, defining the biologic processes corresponding to the clinical phenotype remains challenging. We have examined biomarkers associated with renal stress plus markers of glomerular function to assess whether this approach may aid prediction of AKI or other relevant endpoints.Materials & MethodsUrinary [TIMP-2]·[IGFBP7], serum creatinine, plasma cystatin C and plasma proenkephalin 119-159 2 were analyzed in patients enrolled in the prospective, international, Sapphire study. Heterogenous critically ill patients (n = 723) were examined with a primary endpoint of development of KDIGO stage 2-3 within 12 h and a secondary endpoint of major adverse kidney events at 30 days (MAKE30).Results100 patients (14%) reached the primary endpoint. Markers of renal stress outperformed those associated with glomerular function. Combining [TIMP-2]•[IGFBP7] with serum creatinine, but not the other functional markers, significantly (p = 0.02) increased the area under the ROC curve (AUC) from 0.80 (0.76-0.84) to 0.85 (0.81-0.89). In patients who did not develop AKI, all markers of glomerular filtration, but not [TIMP-2]·[IGFBP7], were significantly elevated in patients with a history of CKD (p < 0.05).ConclusionsThe combination of cell-cycle arrest biomarkers, TIMP-2 and IGFBP7, with serum creatinine but not cystatin C or PENK improved risk stratification for the development of stage 2 or 3 AKI over [TIMP-2]·[IGFBP7] alone.Copyright © 2022 Elsevier Inc. All rights reserved.

11 keywords...

hide…