• Dirk van Lier, Remi Beunders, Matthijs Kox, and Peter Pickkers.
• Department of Intensive Care Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands.
• J Crit Care. 2023 Dec 1; 78: 154383154383.

PurposeBiomarkers independently associated with outcome of intensive care unit (ICU) patients can improve risk assessment. The cytosolic protease dipeptidyl-peptidase 3 (DPP3) is released into the circulation upon cell necrosis. We aimed to investigate the prognostic properties of cDPP3 in a mixed-admission ICU cohort.Materials And MethodsProspective observational study in 650 adult ICU patients. cDPP3 concentrations were measured at ICU admission (day 1), and on days 2 and 3.ResultscDPP3 concentrations on days 1 and 2, but not on day 3 were associated with 28-day mortality; HR 1.36 (95%CI 1.01-1.83, p = 0.043) and HR 1.49 (95%CI 1.16-1.93, p = 0.002) for days 1 and 2, respectively. cDPP3 was also associated with acute kidney injury (AKI), with OR's of 1.31 (95%CI 1.05-1.64, p = 0.016), 1.87 (95%CI 1.51-2.34, p < 0.001) and 1.49 (95%CI 1.16-1.92, p = 0.002) for measurements performed on days 1, 2, and 3, respectively. In multivariate analyses including SOFA or APACHE-II scores, cDPP3 assessed at day 2 of admission remained an independent predictor of mortality and all-stage AKI.ConclusionsIn a mixed-ICU cohort, cDPP3 concentrations after start of initial treatment were independently associated with both mortality and development of AKI. Therefore, measurement of cDPP3 can improve risk-stratification provided by established disease severity scores.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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