Combination of biomarker with clinical risk factors for prediction of severe acute kidney injury in critically ill patients

Abstract

Background Acute kidney injury (AKI) occurs commonly in the intensive care unit (ICU). Insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinase-2 (TIMP-2), known as [TIMP-2] x [IGFBP7] (NephroCheck), have been identified as novel biomarkers for the prediction of AKI risk. However, the effective use of disease biomarkers is indispensable from an appropriate clinical context. We conducted a retrospective cohort study to find risk factors and assess the performance of the combination of NephroCheck with risk factors, so as to provide feasible information for AKI prediction. Methods All patients who were admitted in the ICU (from June 2016 to July 2017) participated in the study. The primary outcome was the detection of severe AKI within the first 7 days after patients being admitted to the ICU. The predictors were separated into three categories: chronic risk factors, acute risk factors and biochemical indicators. Results The study included 577 patients. 96 patients developed to severe AKI (16.6%) within 7 days. In addition to NephroCheck (+) (OR = 2.139, 95% CI (1.260–3.630), P = 0.005), age > 65 years (OR = 1.961, 95% CI (1.153–3.336), P = 0.013), CKD (OR = 2.573, 95% CI (1.319–5.018), P = 0.006) and PCT (+)(OR = 3.223, 95% CI (1.643–6.321), P = 0.001) were also the independent predictors of severe AKI within 7 days. Compared to NephroCheck (+) only (AUC = 0.66, 95% CI:0.60–0.72), the combination of NephroCheck (+) and risk factors (age > 65 years, CKD and PCT positive) (AUC = 0.75, 95% CI:0.70–0.81) led to a significant increase in the area under ROC curve for severe AKI prediction within 7 days. Conclusions Although NephroCheck is an effective screening tool for recognizing high-risk patients, we found that combination with biomarker and risk factors (age > 65 years, CKD, procalcitonin positive) for risk assessment of AKI has the greatest significance to patients with uncertain disease trajectories.

Prognostic Value of Systemic Immune-Inflammation Index among Critically Ill Patients with Acute Kidney Injury: A Retrospective Cohort Study

“…SII integrates the predictive power of the three indicators (neutrophils, lymphocytes and platelet counts), which may potentially reflect the balance of the inflammatory, immune and thrombotic pathways. Furthermore, compared to other new biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloprotease-2 (TIMP-2) and high mobility group box-1 (HMGB-1), SII is convenient and cost-effective [ 37 , 38 , 39 ]. Hu et al [ 15 ] found that SII contributed to the risk stratification of hepatocellular carcinoma (HCC) patients.…”

The relationship between Nephrocheck® test values, outcomes, and urinary output in critically ill patients at risk of acute kidney injury

“…Similarly, in another study of Nephrocheck®, its predictive performance was also low 21 . In a further study of 577 ICU patients, Nephrocheck®'s AUROC for AKI was also reported at 0.66 22 …”

Steering Away from Current Amoxicillin Dose Reductions in Hospitalized Patients with Impaired Kidney Function to Avoid Subtherapeutic Drug Exposure

“…Serum creatinine-based estimates are known to have limitations, especially in ICU patients [ 28 ]. Numerous novel diagnostic biomarkers have been identified over recent years [ 28 , 29 , 30 , 31 ]. These biomarkers have proven useful in predicting acute kidney injury and, in some cases, outperform serum creatinine.…”