CCL14 testing to guide clinical practice in patients with AKI: Results from an international expert panel

John A Kellum; Sean M Bagshaw; Sevag Demirjian; Lui Forni; Michael Joannidis; J Patrick Kampf; Jay L Koyner; Thomas Kwan; Paul McPherson; Marlies Ostermann; John Prowle; Claudio Ronco; Julia de la Salle; Antoine Schneider; Ashita Tolwani; Alexander Zarbock

doi:10.1016/j.jcrc.2024.154816

CCL14 testing to guide clinical practice in patients with AKI: Results from an international expert panel

J Crit Care. 2024 Apr 27:82:154816. doi: 10.1016/j.jcrc.2024.154816. Online ahead of print.

Authors

John A Kellum¹, Sean M Bagshaw², Sevag Demirjian³, Lui Forni⁴, Michael Joannidis⁵, J Patrick Kampf⁶, Jay L Koyner⁷, Thomas Kwan⁶, Paul McPherson⁶, Marlies Ostermann⁸, John Prowle⁹, Claudio Ronco¹⁰, Julia de la Salle¹¹, Antoine Schneider¹², Ashita Tolwani¹³, Alexander Zarbock¹⁴

Affiliations

¹ The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: kellum@pitt.edu.
² Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada.
³ Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Intensive Care, Royal Surrey Hospital, Guildford and Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, UK.
⁵ Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
⁶ Astute Medical, Inc. (A bioMérieux Company), 3550 General Atomics Ct., San Diego, CA 92121, USA.
⁷ Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA.
⁸ King's College London, Guy's & St Thomas' Hospital, London, UK.
⁹ Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK.
¹⁰ Department of Nephrology, Dialysis and transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy.
¹¹ bioMérieux, SA, Global Medical Affairs, Marcy-l'Étoile, France.
¹² Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
¹³ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁴ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Munster, Munster, Germany.

PMID: 38678981
DOI: 10.1016/j.jcrc.2024.154816

Abstract

Purpose: Urinary C-C motif chemokine ligand 14 (CCL14) is a strong predictor of persistent stage 3 acute kidney injury (AKI). Multiple clinical actions are recommended for AKI but how these are applied in individual patients and how the CCL14 test results may impact their application is unknown.

Methods: We assembled an international panel of 12 experts and conducted a modified Delphi process to evaluate patients at risk for persistent stage 3 AKI (lasting 72 hours or longer). Using a Likert scale, we rated 11 clinical actions based on international guidelines applied to each case before and after CCL14 testing and analyzed the association between the strength and direction of recommendations and CCL14 results.

Results: The strength and direction of clinical recommendations were strongly influenced by CCL14 results (P < 0.001 for the interaction). Nine (82%) recommendations for clinical actions were significantly impacted by CCL14 results (P < 0.001 comparing low to highest CCL14 risk category).

Conclusions: Most recommendations for care of patients with stage 2-3 by an international panel of experts were strongly modified by CCL14 test results. This work should set the stage for clinical practice protocols and studies to determine the effects of recommended actions informed by CCL14.

Keywords: Acute kidney injury; Biomarkers; CCL14; Clinical practice guidelines; Recovery.