Influence of patients’ clinical features at intensive care unit admission on performance of cell cycle arrest biomarkers in predicting acute kidney injury

AbstractObjectivesIdentification of acute kidney injury (AKI) can be challenging in patients with a variety of clinical features at intensive care unit (ICU) admission, and the capacity of biomarkers in this subpopulation has been poorly studied. In our study we examined the influence that patients’ clinical features at ICU admission have over the predicting ability of the combination of urinary tissue inhibitor of metalloproteinase-2 (TIMP2) and insulin-like growth factor binding protein 7 (IGFBP7).MethodsUrinary [TIMP2]•[IGFBP7] were measured for all patients upon admission to ICU. We calculated the receiver operating characteristics (ROC) curves for AKI prediction in the overall cohort and for subgroups of patients according to etiology of ICU admission, which included: sepsis, trauma, neurological conditions, cardiovascular diseases, respiratory diseases, and non-classifiable causes.ResultsIn the overall cohort of 719 patients, 239 (33.2%) developed AKI in the first seven days. [TIMP2]•[IGFBP7] at ICU admission were significantly higher in AKI patients than in non-AKI patients. This is true not only for the overall cohort but also in the other subgroups. The area under the ROC curve (AUC) for [TIMP2]•[IGFBP7] in predicting AKI in the first seven days was 0.633 (95% CI 0.588–0.678), for the overall cohort, with sensitivity and specificity of 66.1 and 51.9% respectively. When we considered patients with combined sepsis, trauma, and respiratory disease we found a higher AUC than patients without these conditions (0.711 vs. 0.575; p=0.002).ConclusionsThe accuracy of [TIMP2]•[IGFBP7] in predicting the risk of AKI in the first seven days after ICU admission has significant variability when the reason for ICU admission is considered.

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Incidence, Risk factors, and Biomarkers Predicting Ischemic or Hemorrhagic Stroke Associated Acute Kidney Injury and Outcome: A Retrospective Study in a General Intensive Care Unit

Blood Purification ◽

10.1159/000499029 ◽

2019 ◽

Vol 47 (4) ◽

pp. 317-326 ◽

Cited By ~ 3

Author(s):

Fang Jiang ◽

Lianjiu Su ◽

Hui Xiang ◽

Xiaoyi Zhang ◽

Dongxue Xu ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Hemorrhagic Stroke ◽

Kidney Injury ◽

Roc Curves ◽

Regression Analyses ◽

Stroke Patients ◽

Icu Admission

Objective: We investigated the epidemiology, risk factors, and predictive parameters for ischemic or hemorrhagic stroke-associated acute kidney injury (AKI) and mortality in a general intensive care unit (ICU) in China. Methods: During 5 years, 479 stroke patients were screened, and 381 were enrolled. AKI was diagnosed within 7 days after ICU admission, based on the Kidney Disease Improving Global Outcomes criteria. Risk factors of AKI were assessed by Logistic regression analyses, and the predictive biomarkers for AKI were determined using receiver operating characteristic (ROC) curves. Also examined were factors influencing 28-day mortality, using Cox regression analyses and Kaplan-Meier curves. Results: Among all, 115 (30.18%) patients developed AKI. Multivariate regression analyses revealed that the following features at ICU admission significantly increased the risk of developing AKI: an increased National Institutes of Health Stroke Scale score (OR 1.136, p < 0.001) and Acute Physiology and Chronic Health Evaluation II score (OR 1.107, p = 0.042); hypertension (OR 2.346, p = 0.008); use of loop diuretics (OR 1.961, p = 0.032); and higher serum cystatin C (sCysC; OR 8.156, p = 0.001). The area under the ROC curves for predicting AKI using sCysC was 0.772, slightly better than that of other biomarkers. The sCysC ≥0.93 mg/L (hazard ratio 1.844, p = 0.004) significantly predicted 28-day mortality. Conclusions: Among stroke patients in ICU, we identified significant risk factors of stroke-associated AKI. Serum CysC level at ICU admission was an important biomarker for predicting AKI and 28-day mortality.

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Plasma neutrophil gelatinase-associated lipocalin at intensive care unit admission as a predictor of acute kidney injury progression

Clinical Kidney Journal ◽

10.1093/ckj/sfaa002 ◽

2020 ◽

Vol 13 (6) ◽

pp. 994-1002 ◽

Cited By ~ 1

Author(s):

Jacqueline Koeze ◽

Iwan C C van der Horst ◽

Frederik Keus ◽

Renske Wiersema ◽

Wim Dieperink ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Roc Curve ◽

Kidney Injury ◽

Operating Characteristics ◽

Icu Admission ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Neutrophil Gelatinase

Abstract Background Acute kidney injury (AKI) is a common complication in patients during intensive care unit (ICU) admission. AKI is defined as an increase in serum creatinine (SCr) and/or a reduction in urine output. SCr is a marker of renal function with several limitations, which led to the search for biomarkers for earlier AKI detection. Our aim was to study the predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) at admission as a biomarker for AKI progression during the first 48 h of ICU admission in an unselected, heterogeneous ICU patient population. Methods We conducted a prospective observational study in an academic tertiary referral ICU population. We recorded AKI progression in all ICU patients during the first 48 h of ICU admission in a 6-week period. Plasma NGAL was measured at admission but levels were not reported to the attending clinicians. As possible predictors of AKI progression, pre-existing AKI risk factors were recorded. We examined the association of clinical parameters and plasma NGAL levels at ICU admission with the incidence and progression of AKI within the first 48 h of the ICU stay. Results A total of 361 patients were included. Patients without AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 115 ng/mL [interquartile range (IQR) 81–201]. Patients with AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 156 ng/mL (IQR 97–267). To predict AKI progression, a multivariant model with age, sex, diabetes mellitus, body mass index, admission type, Acute Physiology and Chronic Health Evaluation score and SCr at admission had an area under the receiver operating characteristics (ROC) curve of 0.765. Adding NGAL to this model showed a small increase in the area under the ROC curve to 0.783 (95% confidence interval 0.714–0.853). Conclusions NGAL levels at admission were higher in patients with progression of AKI during the first 48 h of ICU admission, but adding NGAL levels at admission to a model predicting this AKI progression showed no significant additive value.

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Acute kidney injury and continuous renal replacement therapy: A nursing perspective for my shift today in the intensive care unit

Seminars in Dialysis ◽

10.1111/sdi.12992 ◽

2021 ◽

Author(s):

Ian Baldwin ◽

Theresa Mottes

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury

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POS-007 MAGNITUDE AND ASSOCIATED RISK FACTORS OF NEONATAL ACUTE KIDNEY INJURY IN THE NEONATAL INTENSIVE CARE UNIT OF TIKUR ANBESSA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHOPIA

Kidney International Reports ◽

10.1016/j.ekir.2021.03.013 ◽

2021 ◽

Vol 6 (4) ◽

pp. S3

Author(s):

H. Nida ◽

A. Demtse ◽

B.A. Bekele

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Addis Ababa ◽

Kidney Injury ◽

Specialized Hospital ◽

Tikur Anbessa Specialized Hospital ◽

Associated Risk Factors

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POS-004 HYPOALBUMINEMIA AND ACUTE KIDNEY INJURY IN PATIENTS ADMITTED TO INTENSIVE CARE UNIT

Kidney International Reports ◽

10.1016/j.ekir.2021.03.010 ◽

2021 ◽

Vol 6 (4) ◽

pp. S2

Author(s):

A. BACA ◽

M. Carmoma Antonio ◽

M. Wasung ◽

P. Visoso ◽

M. Sebastian Alberto

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Injury

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Influence of volume administration on Doppler-based renal resistive index, renal hemodynamics and renal function in medical intensive care unit patients with septic-induced acute kidney injury: a pilot study

International Urology and Nephrology ◽

10.1007/s11255-016-1312-1 ◽

2016 ◽

Vol 48 (8) ◽

pp. 1327-1334 ◽

Cited By ~ 9

Author(s):

Tobias Lahmer ◽

Sebastian Rasch ◽

Christopher Schnappauf ◽

Roland M. Schmid ◽

Wolfgang Huber

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Pilot Study ◽

Medical Intensive Care Unit ◽

Resistive Index ◽

Kidney Injury ◽

Renal Resistive Index ◽

Medical Intensive Care

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Dosing of daptomycin in intensive care unit patients with acute kidney injury undergoing extended dialysis--a pharmacokinetic study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfp704 ◽

2009 ◽

Vol 25 (5) ◽

pp. 1537-1541 ◽

Cited By ~ 51

Author(s):

J. T. Kielstein ◽

C. Eugbers ◽

S. M. Bode-Boeger ◽

J. Martens-Lobenhoffer ◽

H. Haller ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Pharmacokinetic Study ◽

Kidney Injury

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Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

Journal of the Intensive Care Society ◽

10.1177/1751143718762685 ◽

2018 ◽

Vol 19 (4) ◽

pp. 313-318 ◽

Cited By ~ 1

Author(s):

Prashant Parulekar ◽

Ed Neil-Gallacher ◽

Alex Harrison

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Point Of Care ◽

Kidney Injury ◽

Diagnostic Quality ◽

The Core ◽

Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

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