External validation of urinary C–C motif chemokine ligand 14 (CCL14) for prediction of persistent acute kidney injury

Autor: Bagshaw, Sean M., Al-Khafaji, Ali, Artigas Raventós, Antoni, Davison, Danielle, Haase, Michael, Lissauer, Matthew, Zacharowski, Kai, Chawla, Lakhmir S., Kwan, Thomas, Kampf, J. Patrick, McPherson, Paul, Kellum, John A., Universitat Autònoma de Barcelona
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Urinary system
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
urologic and male genital diseases
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Predictive Value of Tests
Internal medicine
Diabetes mellitus
Validation
medicine
Clinical endpoint
Humans
030212 general & internal medicine
Renal replacement therapy
Prospective Studies
Mortality
APACHE
Aged
Creatinine
Receiver operating characteristic
business.industry
urogenital system
RC86-88.9
Research
Acute kidney injury
Medical emergencies. Critical care. Intensive care. First aid
Middle Aged
medicine.disease
female genital diseases and pregnancy complications
chemistry
ROC Curve
Area Under Curve
Chemokines
CC
Female
business
Prediction
Biomarkers
Kidney disease
Zdroj: Critical Care, Vol 25, Iss 1, Pp 1-8 (2021)
Critical Care
ISSN: 1364-8535
Popis: Background Persistent acute kidney injury (AKI) portends worse clinical outcomes and remains a therapeutic challenge for clinicians. A recent study found that urinary C–C motif chemokine ligand 14 (CCL14) can predict the development of persistent AKI. We aimed to externally validate urinary CCL14 for the prediction of persistent AKI in critically ill patients. Methods This was a secondary analysis of the prospective multi-center SAPPHIRE study. We evaluated critically ill patients with cardiac and/or respiratory dysfunction who developed Kidney Disease: Improving Global Outcomes (KDIGO) stage 2–3 AKI within one week of enrollment. The main exposure was the urinary concentration of CCL14 measured at the onset of AKI stage 2–3. The primary endpoint was the development of persistent severe AKI, defined as ≥ 72 h of KDIGO stage 3 AKI or death or renal-replacement therapy (RRT) prior to 72 h. The secondary endpoint was a composite of RRT and/or death by 90 days. We used receiver operating characteristic (ROC) curve analysis to assess discriminative ability of urinary CCL14 for the development of persistent severe AKI and multivariate analysis to compare tertiles of urinary CCL14 and outcomes. Results We included 195 patients who developed KDIGO stage 2–3 AKI. Of these, 28 (14%) developed persistent severe AKI, of whom 15 had AKI ≥ 72 h, 12 received RRT and 1 died prior to ≥ 72 h of KDIGO stage 3 AKI. Persistent severe AKI was associated with chronic kidney disease, diabetes mellitus, higher non-renal APACHE III score, greater fluid balance, vasopressor use, and greater change in baseline serum creatinine. The AUC for urinary CCL14 to predict persistent severe AKI was 0.81 (95% CI, 0.72–0.89). The risk of persistent severe AKI increased with higher values of urinary CCL14. RRT and/or death at 90 days increased within tertiles of urinary CCL14 concentration. Conclusions This secondary analysis externally validates urinary CCL14 to predict persistent severe AKI in critically ill patients.
Databáze: OpenAIRE
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