Matthieu Legrand1,2,3, Alexa Hollinger1,2,4, Antoine Vieillard-Baron5,6,7, François Dépret1,2,3, Alain Cariou8, Nicolas Deye9, Marie-Céline Fournier1,2, Samir Jaber10, Charles Damoisel1, Qin Lu11, Xavier Monnet12, Isabelle Rennuit13, Michael Darmon14, Lara Zafrani14, Marc Leone15, Bertrand Guidet16, Diane Friedman17, Romain Sonneville18, Philippe Montravers19, Sébastien Pili-Floury20, Jean-Yves Lefrant21,22, Jacques Duranteau23, Pierre-François Laterre24, Nicolas Brechot25, Haikel Oueslati1, Bernard Cholley26, Jean-Marie Launay2,27, Shiro Ishihara1,28, Naoki Sato1,28, Alexandre Mebazaa1,2,3, Etienne Gayat1,2,3. 1. Department of Anaesthesiology, Critical Care Medicine and Burn unit, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France. 2. INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière hospital and INI-CRCT network, Paris, France. 3. Université Paris Diderot, F-75475, Paris, France. 4. Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland. 5. University Hospital Ambroise Paré, Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France. 6. INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France. 7. Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin en Yvelines, France. 8. Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 9. Medical Intensive Care Unit, Hôpitaux Universitaires Saint Louis, Lariboisière, Assistance Publique, Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France. 10. Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, Centre Hospitalier, Montpellier, France. 11. Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, UPMC Paris 6, Paris, France. 12. Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, Inserm UMR_S999, Paris-Sud University, Le Kremlin-Bicetre, France. 13. Department of Anesthesiology and Critical Care, Beaujon Hospital, Assistance Publique Hôpitaux de Paris University, Clichy, France. 14. Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université Paris Diderot Sorbonne, Paris, France. 15. Aix Marseille University, APHM, Department of Anesthesiology and Critical Care Medicine, Marseille, France. 16. Medical Intensive Care Unit, Department of Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 17. Department of Anesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris Sudden Death Expertise Center, Paris, France. 18. Department of Intensive Care Medicine and Infectious Diseases, Univ Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude, Paris, France. 19. Department of Anesthesiology and Intensive Care, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France. 20. Department of Anesthesiology and Intensive Care Medicine, Besançon University Hospital, Besançon, France EA 3920, University of Bourgogne Franche-Comté, Besançon, France. 21. Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Nimes University Hospital, Nîmes, France. 22. Female characteristics of endothelium dysfunction, EA 2992, Faculté de Médecine de Nîmes, Université Montpellier 1, Nîmes, France. 23. Department of Anesthesiology and Critical Care, Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France. 24. Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium. 25. INSERM, U833, Paris, France, Laboratoire Angiogenèse Embryonnaire et Pathologique, Collège de France, Paris, France. 26. Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Paris 5, Paris, France. 27. Centre for Biological Resources BB-0033-00064, Lariboisière Hospital, Paris, France. 28. Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan.
Abstract
OBJECTIVES: The association between outcome and kidney injury detected at discharge from the ICU using different biomarkers remains unknown. The objective was to evaluate the association between 1-year survival and kidney injury at ICU discharge. DESIGN: Ancillary investigation of a prospective observational study. SETTING: Twenty-one ICUs with 1-year follow-up. PATIENTS: Critically ill patients receiving mechanical ventilation and/or hemodynamic support for at least 24 hours were included. INTERVENTIONS: Serum creatinine, plasma Cystatin C, plasma neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, plasma Proenkephalin A 119-159, and estimated glomerular filtration rate (on serum creatinine and plasma Cystatin C) were measured at ICU discharge among ICU survivors. MEASUREMENTS AND MAIN RESULTS: The association between kidney biomarkers at discharge and mortality was estimated using logistic model with and without adjustment for prognostic factors previously identified in this cohort. Subgroup analyses were performed in patients with discharge serum creatinine less than 1.5-fold baseline at ICU discharge. Among 1,207 ICU survivors included, 231 died during the year following ICU discharge (19.2%). Estimated glomerular filtration rate was significantly lower and kidney injury biomarkers higher at discharge in nonsurvivors. The association between biomarker levels or estimated glomerular filtration rate and mortality remained after adjustment to potential cofounding factors influencing outcome. In patients with low serum creatinine at ICU discharge, 25-47% of patients were classified as subclinical kidney injury depending on the biomarker. The association between kidney biomarkers and mortality remained and mortality was higher than patients without subclinical kidney injury. The majority of patients who developed acute kidney injury during ICU stay had elevated biomarkers of kidney injury at discharge even with apparent recovery based on serum creatinine (i.e., subclinical acute kidney disease). CONCLUSIONS: Elevated kidney biomarkers measured at ICU discharge are associated with poor 1-year outcome, including in patients with low serum creatinine at ICU discharge.
OBJECTIVES: The association between outcome and kidney injury detected at discharge from the ICU using different biomarkers remains unknown. The objective was to evaluate the association between 1-year survival and kidney injury at ICU discharge. DESIGN: Ancillary investigation of a prospective observational study. SETTING: Twenty-one ICUs with 1-year follow-up. PATIENTS: Critically illpatients receiving mechanical ventilation and/or hemodynamic support for at least 24 hours were included. INTERVENTIONS: Serum creatinine, plasma Cystatin C, plasma neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, plasma Proenkephalin A 119-159, and estimated glomerular filtration rate (on serum creatinine and plasma Cystatin C) were measured at ICU discharge among ICU survivors. MEASUREMENTS AND MAIN RESULTS: The association between kidney biomarkers at discharge and mortality was estimated using logistic model with and without adjustment for prognostic factors previously identified in this cohort. Subgroup analyses were performed in patients with discharge serum creatinine less than 1.5-fold baseline at ICU discharge. Among 1,207 ICU survivors included, 231 died during the year following ICU discharge (19.2%). Estimated glomerular filtration rate was significantly lower and kidney injury biomarkers higher at discharge in nonsurvivors. The association between biomarker levels or estimated glomerular filtration rate and mortality remained after adjustment to potential cofounding factors influencing outcome. In patients with low serum creatinine at ICU discharge, 25-47% of patients were classified as subclinical kidney injury depending on the biomarker. The association between kidney biomarkers and mortality remained and mortality was higher than patients without subclinical kidney injury. The majority of patients who developed acute kidney injury during ICU stay had elevated biomarkers of kidney injury at discharge even with apparent recovery based on serum creatinine (i.e., subclinical acute kidney disease). CONCLUSIONS: Elevated kidney biomarkers measured at ICU discharge are associated with poor 1-year outcome, including in patients with low serum creatinine at ICU discharge.
Authors: Sabri Soussi; Divya Sharma; Peter Jüni; Gerald Lebovic; Laurent Brochard; John C Marshall; Patrick R Lawler; Margaret Herridge; Niall Ferguson; Lorenzo Del Sorbo; Elodie Feliot; Alexandre Mebazaa; Erica Acton; Jason N Kennedy; Wei Xu; Etienne Gayat; Claudia C Dos Santos Journal: Crit Care Date: 2022-04-21 Impact factor: 19.334