Natalja Stanski1, Shina Menon2, Stuart L Goldstein3, Rajit K Basu4. 1. Cincinnati Children's Hospital Medical Center, Division of Critical Care Medicine, 3333 Burnet Avenue, MLC 2005, Cincinnati, OH 45229, United States of America. Electronic address: natalja.stanski@cchmc.org. 2. University of Washington School of Medicine, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, United States of America. Electronic address: shina.menon@seattlechildrens.org. 3. Cincinnati Children's Hospital Medical Center, Center for Acute Care Nephrology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, United States of America. Electronic address: stuart.goldstein@cchmc.org. 4. Children's Healthcare of Atlanta, Division of Critical Care Medicine, United States of America. Electronic address: rajit.basu@choa.org.
Abstract
PURPOSE: Acute kidney injury (AKI) is prevalent in critically ill patients and associated with poor outcomes. Current AKI diagnostics- changes to serum creatinine (SCr) and urine output- are imprecise. Integration of injury biomarkers with SCr may improve diagnostic precision. METHODS: We performed a secondary analysis of a study of critically ill children. Measurements of urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr samples from ICU admission facilitated the creation of four groups for comparison, based on elevation of SCr from baseline and reference NGAL cut-off value: uNGAL-/SCr-, uNGAL+/SCr-, uNGAL-/SCr + and uNGAL+/SCr+. The primary outcome assessed was AKI severity on Day 3. RESULTS: 178 children were studied. Compared to uNGAL-/SCr-, uNGAL+/SCr- patients had increased risk for all-stage Day 3 AKI (≥ KDIGO stage 1) (OR 3.83, [1.3-11.3], p = .025). Compared to uNGAL-/SCr+, uNGAL+/SCr + patients had increased risk for severe Day 3 AKI (≥ KDIGO stage 2) (OR 12, [1.4-102], p = .018). The only patients to suffer all-stage Day 3 AKI and mortality were uNGAL+ (3.2% uNGAL+/SCr-; 6.5% uNGAL+/SCr+). CONCLUSIONS: Unique biomarker combinations on admission are predictive of distinct Day 3 AKI severity phenotypes. These classifications may enable a more personalized approach to the early management of AKI. Expanded study in larger populations is warranted.
PURPOSE:Acute kidney injury (AKI) is prevalent in critically illpatients and associated with poor outcomes. Current AKI diagnostics- changes to serum creatinine (SCr) and urine output- are imprecise. Integration of injury biomarkers with SCr may improve diagnostic precision. METHODS: We performed a secondary analysis of a study of critically illchildren. Measurements of urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr samples from ICU admission facilitated the creation of four groups for comparison, based on elevation of SCr from baseline and reference NGAL cut-off value: uNGAL-/SCr-, uNGAL+/SCr-, uNGAL-/SCr + and uNGAL+/SCr+. The primary outcome assessed was AKI severity on Day 3. RESULTS: 178 children were studied. Compared to uNGAL-/SCr-, uNGAL+/SCr- patients had increased risk for all-stage Day 3 AKI (≥ KDIGO stage 1) (OR 3.83, [1.3-11.3], p = .025). Compared to uNGAL-/SCr+, uNGAL+/SCr + patients had increased risk for severe Day 3 AKI (≥ KDIGO stage 2) (OR 12, [1.4-102], p = .018). The only patients to suffer all-stage Day 3 AKI and mortality were uNGAL+ (3.2% uNGAL+/SCr-; 6.5% uNGAL+/SCr+). CONCLUSIONS: Unique biomarker combinations on admission are predictive of distinct Day 3 AKI severity phenotypes. These classifications may enable a more personalized approach to the early management of AKI. Expanded study in larger populations is warranted.
Authors: Simona Riccio; Maria Sole Valentino; Antonio Paride Passaro; Marica Izzo; Stefano Guarino; Emanuele Miraglia Del Giudice; Pierluigi Marzuillo; Anna Di Sessa Journal: Children (Basel) Date: 2022-01-17
Authors: Natalja L Stanski; Hector R Wong; Rajit K Basu; Natalie Z Cvijanovich; Julie C Fitzgerald; Scott L Weiss; Michael T Bigham; Parag N Jain; Adam Schwarz; Riad Lutfi; Jeffrey Nowak; Geoffrey L Allen; Neal J Thomas; Jocelyn R Grunwell; Michael Quasney; Bereketeab Haileselassie; Lakhmir S Chawla; Stuart L Goldstein Journal: Kidney Int Rep Date: 2021-05-01