Assessment of Urinary Netrin-1 as a Marker for Progression of Acute Kidney Injury in Critically Ill Patients: Prospective Cohort Study

Abstract

Background and objective: This study aimed to identify risk factors for progression of AKI in critically ill adult patients in the medical ICU in Alexandria main University Hospitals and to assess urinary netrin-1 as a marker for progression of AKI. Design, setting, participants and measurements: The study included 80 AKI patients who were followed during their ICU stay for primary outcome (progression to severe AKI; KDIGO stage 2 or 3) and secondary outcomes (need for RRT, ICU mortality, length of ICU stay and SCr at the time of discharge from the ICU). All participants were subjected to history taking, full clinical examination and laboratory (routine and specific) investigations. Urine samples were collected for all patients at the time of ICU admission and urinary netrin-1 was measured. Result: Almost one third (33.75%) of the study patients were identified as progressors. Progression was significantly more common among patients with history of CKD (p<0.001), hypotensive patients (p=0.002), septic patients (p=0.041), those who needed RRT (p<0.001) and those who died (p=0.003). Progressors had lower MBP and serum albumin level (p=0.007, 0.008, respectively). They had higher APACHE II score and longer ICU stay (p=0.037, 0.020, respectively). They also had higher basal blood urea, basal SCr and SCr levels at the time of presentation and discharge (p<0.001 for all). The results were similar between progressors and non-progressors, those who received RRT and those who did not and survivors and non-survivors as regards urinary netrin-1 levels. Results of the multivariate analysis revealed that CVD, hypotension and higher basal blood urea level were independent risk factors for AKI progression. Conclusion: The results of this study suggest that history of CKD, hypotension and sepsis are associated with progression of AKI in critically ill patients and that urinary netrin-1 has no significant value as a predictor of AKI progression, need for RRT or ICU mortality.