Abstract: TH-PO096
Comparison of Urinary Biomarkers in Critically Ill Children: Early Detection of AKI, Prediction of Mortality, and Confounding Factors
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Li, Yanhong, children hospital of Soochow University, Suzhou, JiangSu, China
Background
Most AKI biomarkers are susceptible to confounding factors in the prediction. We aimed to compare the performance of urinary biomarkers for early detection of AKI and the prediction of PICU mortality, and investigate the impact of confounding factors on these biomarkers in critically ill children.
Methods
Urine samples were serially collected in 123 children during the first 7 d of PICU stay for measurement of NGAL, KIM-1, TIMP2, IGFBP7, L-FABP, TIMP1, Renin, trefoil factor 3 (TFF-3), interferon-inducible protein-10 (IP-10). AKI diagnosis was based on KDIGO classification.
Results
Of the children, 35 developed AKI, including 12 with stage 1, 14 with stage 2 and 9 with stage 3, and 15 died during PICU stay.
(1). The initial urinary biomarkers, associated with AKI stage 3 in univariate analysis, were TIMP1, KIM-1, NGAL, TIMP2, Renin and L-FABP; and achieved AUC of 0.75, 074, 0.74, 0.71, 0.70, and 0.68 for early detection of AKI stage 3. The initial TIMP1, TIMP2, NGAL, IP-10, KIM-1, L-FABP, TFF-3, Renin and IGFBP-7 achieved AUC of 0.84, 079, 0.78, 0.77, 0.76, 0.74, 0.73, 0.67 and 0.65 for predicting mortality. However, only initial TIMP1 remained associated with AKI stage 3 (P=0.016) and mortality (P=0.038) after adjustment for age, body weight and illness severity.
(2). Peak urinary KIM-1 and TIMP2 remained associated with AKI stage 3; and peak KIM-1, NGAL, L-FABP, and IP-10 remained associated with mortality after adjustment.
(3). Illness severity assessed by PRISM III was identified as an independent factor associated with all the initial and peak urinary biomarkers. Sepsis had an impact on initial and peak levels of NGAL, KIM-1 and IP-10 and peak Renin levels. Furosemide was independently associated with initial and peak levels of NGAL, L-FABP, TIMP1 and Renin and peak KIM-1, TIMP2 and TFF3 levels.
Conclusion
Although a higher initial urinary level of TIMP1, NGAL, KIM-1, TIMP2, Renin or L-FABP is predictive of severe AKI and mortality in critically ill children, these urinary biomarkers are significantly associated with illness severity and influenced by confounding factors. Sepsis has an impact on levels of NGAL, KIM-1, Renin and IP-10. Furosemide affects NGAL, FABP-1, TIMP1 and Renin. Sepsis appeared not to have impact on urinary TIMP1 and TIMP2, in contrast to NGAL and KIM-1, in critically ill children.