Abstract: PO0138
Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients
Session Information
- AKI Clinical, Outcomes, and Trials - 2
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Flannery, Alexander H., University of Kentucky College of Pharmacy, Lexington, Kentucky, United States
- Ortiz-Soriano, Victor M., University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Gianella, Fabiola, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
- Prado, Victor E., University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
- Toto, Robert D., University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
- Moe, Orson W., University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
- Neyra, Javier A., University of Kentucky College of Medicine, Lexington, Kentucky, United States
Background
Several biomarkers of acute kidney injury (AKI) have been examined for their ability to predict AKI earlier than serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research.
Methods
Single-center prospective study collecting blood and urine samples from critically ill patients with AKI KDIGO stage 2 or above, and matched controls from a single, tertiary care intensive care unit. Samples were collected at 24-48 hours after AKI diagnosis (cases) or ICU admission (controls), 5-7 days later, and 4-6 weeks following discharge for AKI patients. The primary outcome of interest was MAKE at hospital discharge.
Results
Serum/urinary neutrophil gelatinase-associated lipocalin, serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE compared to those not experiencing MAKE. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a clinical prediction model of MAKE as assessed by the area under the receiver operating characteristic curve. Patients without MAKE experienced a greater decline in serum NGAL from initial measurement to second measurement than those patients experiencing MAKE.
Conclusion
Early values of kidney biomarkers in critically ill patients are associated with MAKE. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE.
Figure 1. Kidney Biomarker Trends from Time 1 (24-48 hours) to Time 2 (5-7 Days)
Figure 2. Receiver operating characteristic curves for MAKE-Discharge
Funding
- NIDDK Support