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Abstract: PO0071

Combining Renal Arrest and Damage Biomarkers to Predict the Progression of AKI in Patients with Sepsis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Yang, Xiaobing, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
  • Tao, Xiaolei, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
Background

Septic AKI accounts for approximately half of all AKI in ICU, and up to 40% of mild or moderate septic AKI would progress to more severe AKI which is associated with significantly increased risk for in-hospital death and later CKD/ESRD. Early identifying high risk patients for AKI progression might help physicians to enhance individualized monitoring and personalized management in patients with septic AKI.

Methods

This is a prospective, multicenter cohort study which enrolled adult septic patients who initially developed stage 1 or stage 2 AKI in the ICU from January 2014 to March 2018. Sepsis was diagnosed based on the 2016 Sepsis-3 criteria, and AKI was diagnosed and staged according to 2012 KDIGO-AKI guidelines. Renal arrest biomarkers (urinary TIMP2*IGFBP7 [u TIMP2*IGFBP7])and renal damage biomarkers (urinary KIM-1[uKIM-1] and urinary IL-18 [uIL-18]) were measured at time of AKI clinical diagnosis, and the utility of biomarkers for predicting septic AKI progression alone or in combination were evaluated. The primary outcome was AKI progression defined as worsening of AKI stage. The second outcome was receiving dialysis or death during ICU stay.

Results

A total of 149 septic patients with stage 1 or 2 AKI were included, 63 patient developed progressive AKI, 49 patients received dialysis or died during ICU stay. uTIMP2*IGFBP7, uKIM-1 and uIL-18 independently predicted the progression of septic AKI in which uTIMP2*IGFBP7 showed the greatest AUC (0.745; 95%CI, 0.667-0.823) as compared to uKIM-1 (AUC 0.719; 95%CI 0.638-0.800) and uIL-18 (AUC 0.619; 95%CI 0.525-0.731). Combination of uTIMP2*IGFBP7 with uKIM-1/uIL-18 further improved the performance of predicting septic AKI progression with AUCs of 0.752 (uTIMP2*IGFBP7 with uKIM-1) and 0.747 (uTIMP2*IGFBP7 with uIL-18), respectively. uTIMP2*IGFBP7, alone or combined with uKIM-1/uIL-18, improved the risk reclassification over the clinical risk factor model alone both for the primary and secondary outcomes, as evidenced by significant category-free net reclassification index.

Conclusion

Combination of renal arrest and damage biomarkers enhanced the prediction of AKI progression in patient with sepsis and improved risk reclassification over the clinical risk factor model alone.

Funding

  • Government Support - Non-U.S.