Renal arterial resistive index versus novel biomarkers for the early prediction of sepsis-associated acute kidney injury

Taysser Zaitoun; Mohamed Megahed; Hesham Elghoneimy; Doaa M Emara; Ibrahim Elsayed; Islam Ahmed

doi:10.1007/s11739-024-03558-y

Renal arterial resistive index versus novel biomarkers for the early prediction of sepsis-associated acute kidney injury

Intern Emerg Med. 2024 Mar 6. doi: 10.1007/s11739-024-03558-y. Online ahead of print.

Authors

Taysser Zaitoun¹, Mohamed Megahed², Hesham Elghoneimy³, Doaa M Emara⁴, Ibrahim Elsayed⁵, Islam Ahmed^{6

7}

Affiliations

¹ Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. tayseerzaytoun@gmail.com.
² Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
³ Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
⁴ Radiodiagnosis and Interventional Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
⁵ Critical Care Medicine Department, Faculty of Medicine, KFS University, Kafrelsheikh, Egypt.
⁶ Public Health and Community Medicine Department, Faculty of Medicine, Suez-Canal University, Ismaili, Egypt.
⁷ Pharmacy Practice and Clinical Pharmacy Department, Faculty of Pharmacy, King Salman International University, South-Sinai, Egypt.

PMID: 38446371
DOI: 10.1007/s11739-024-03558-y

Abstract

Acute kidney injury (AKI) is a critical complication of sepsis. There is a continuous need to identify and validate biomarkers for early detection. Serum and urinary biomarkers have been investigated, such as neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cys C), but their reliability in the intensive care unit (ICU) remains unknown. Renal hemodynamics can be investigated by measuring the renal resistive index (RRI). This study aimed to compare the performance of RRI, serum NGAL (sNGAL), urinary NGAL (uNGAL), and serum Cys C levels as early predictors of the diagnosis and persistence of sepsis-associated AKI. A total of 166 adult patients with sepsis syndrome were enrolled immediately after ICU admission. Biomarkers were measured directly (T1) and on day 3 (T3). RRI was measured directly (T1) and 24 h later (T2). Patients were categorized (according to the occurrence and persistence of AKI within the first 7 days) into three groups: no AKI, transient AKI, and persistent AKI. The incidence rate of sepsis-associated AKI was 60.2%. Sixty-six patients were categorized as in the no AKI group, while another 61 were in transient AKI and only 39 were in persistent AKI. The RRI value (T1 ≥ 0.72) was the best tool for predicting AKI diagnosis (area under the receiver operating characteristic curve, AUROC = 0.905). Cys C (T1 ≥ 15.1 mg/l) was the best tool to predict the persistence of AKI (AUROC = 0.977). RRI (T1) was the best predictive tool for sepsis-associated AKI, while Cys C was the best predictor of its persistence and 28-day mortality.

Keywords: Acute kidney injury; Cystatin C; Diagnosis; NGAL; Renal resistive index; Sensitivity and specificity; Sepsis; Sepsis-associated acute kidney injury.