• John A Kellum, Sean M Bagshaw, Sevag Demirjian, Lui Forni, Michael Joannidis, J Patrick Kampf, Jay L Koyner, Thomas Kwan, Paul McPherson, Marlies Ostermann, John Prowle, Claudio Ronco, Julia de la Salle, Antoine Schneider, Ashita Tolwani, and Alexander Zarbock.
• The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: kellum@pitt.edu.
• J Crit Care. 2024 Aug 1; 82: 154816154816.

PurposeUrinary C-C motif chemokine ligand 14 (CCL14) is a strong predictor of persistent stage 3 acute kidney injury (AKI). Multiple clinical actions are recommended for AKI but how these are applied in individual patients and how the CCL14 test results may impact their application is unknown.MethodsWe assembled an international panel of 12 experts and conducted a modified Delphi process to evaluate patients at risk for persistent stage 3 AKI (lasting 72 hours or longer). Using a Likert scale, we rated 11 clinical actions based on international guidelines applied to each case before and after CCL14 testing and analyzed the association between the strength and direction of recommendations and CCL14 results.ResultsThe strength and direction of clinical recommendations were strongly influenced by CCL14 results (P < 0.001 for the interaction). Nine (82%) recommendations for clinical actions were significantly impacted by CCL14 results (P < 0.001 comparing low to highest CCL14 risk category).ConclusionsMost recommendations for care of patients with stage 2-3 by an international panel of experts were strongly modified by CCL14 test results. This work should set the stage for clinical practice protocols and studies to determine the effects of recommended actions informed by CCL14.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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