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

BMC Nephrol. 2020 Dec 10;21(1):540. doi: 10.1186/s12882-020-02202-z.

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.

Keywords: Acute kidney injury; Clinical prediction; Insulin-like growth factor-binding protein 7; Intensive care; Risk factors; Tissue inhibitor of metalloproteinase-2.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / epidemiology*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Clinical Decision Rules
  • Continuous Renal Replacement Therapy
  • Creatinine / blood
  • Critical Illness*
  • Female
  • Hospital Mortality
  • Humans
  • Insulin-Like Growth Factor Binding Proteins / blood*
  • Intensive Care Units
  • Lactic Acid / blood
  • Length of Stay
  • Male
  • Middle Aged
  • Odds Ratio
  • Procalcitonin / blood*
  • Renal Insufficiency, Chronic / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Tissue Inhibitor of Metalloproteinase-2 / blood*

Substances

  • Biomarkers
  • Insulin-Like Growth Factor Binding Proteins
  • Procalcitonin
  • TIMP2 protein, human
  • insulin-like growth factor binding protein-related protein 1
  • Tissue Inhibitor of Metalloproteinase-2
  • Lactic Acid
  • Creatinine