Abstract
BackgroundAcute kidney injury (AKI) is a frequently occurring syndrome in critically ill patients and is associated with worse outcomes. Biomarkers allow early identification and therapy of AKI which may improve outcomes. Urine chitinase 3-like protein 1 (uCHI3L1) was recently identified as a promising urinary biomarker for AKI. In this multicenter study, we evaluated the diagnostic performance for AKI stage 2 or greater of uCHI3L1 in comparison with the urinary cell cycle arrest biomarkers urinary tissue inhibitor of metalloproteinases-2 (TIMP-2)•insulin-like growth factor-binding protein 7 (IGFBP7) measured by NephroCheck Risk®.MethodsPost hoc laboratory study of the prospective observational FINNAKI study. Of this cohort, we included patients with stored admission urine samples and availability of serum creatinine at day 1 of admission. Patients who already had AKI stage 2 or 3 at ICU admission were excluded. AKI was defined and staged according to the KDIGO definition and staging system. The primary endpoint was AKI stage 2 or 3 at day 1. Biomarker performance was assessed by the area under the curve of the receiver operating characteristic curve (AUC). We assessed individual performance and different combinations of urine biomarkers.ResultsOf 660 included patients, 49 (7.4%) had AKI stages 2–3 at day 1. All urine biomarkers were increased at admission in AKI patients. All biomarkers and most combinations had AUCs < 0.700. The combination uCHI3L1•TIMP-2 was best with a fair AUC of 0.706 (0.670, 0.718). uCHI3L1 had a positive likelihood ratio (LR) of 2.25 which was comparable to that of the NephroCheck Risk® cutoff of 2.0, while the negative LR of 0.53 was comparable to that of the NephroCheck Risk® cutoff of 0.3.ConclusionsWe found that uCHI3L1 and NephroCheck Risk® had a comparable diagnostic performance for diagnosis of AKI stage 2 or greater within a 24-h period in this multicenter FINNAKI cohort. In contrast to initial discovery and validation studies, the diagnostic performance was poor. Possible explanations for this observation are differences in patient populations, proportion of emergency admissions, proportion of functional AKI, rate of developing AKI, and observation periods for diagnosis of AKI.
Highlights
Acute kidney injury (AKI) is a frequently occurring syndrome in critically ill patients and is associated with worse outcomes
We found that Urine chitinase 3-like protein 1 (uCHI3L1) and NephroCheck Risk® had a comparable diagnostic performance for diagnosis of AKI stage 2 or greater within a 24-h period in this multicenter Finnish Acute Kidney Injury (FINNAKI) cohort
Recent studies indicate that the incidence of AKI in intensive care unit (ICU) patients varies between 39 and 56% when defined by the Kidney Disease: Improving Global Outcomes (KDIGO) consensus criteria [2,3,4]
Summary
Acute kidney injury (AKI) is a frequently occurring syndrome in critically ill patients and is associated with worse outcomes. Recent studies indicate that the incidence of AKI in ICU patients varies between 39 and 56% when defined by the Kidney Disease: Improving Global Outcomes (KDIGO) consensus criteria [2,3,4]. Kidney biomarkers indicate stress or damage to the kidney tubular cells, giving additional information potentially at an earlier stage than Cr or UO [5] This may be of importance since more early identification and stratification of therapy by the use of AKI biomarkers can improve outcomes [6, 7]. The 2-biomarker panel of the cell cycle arrest biomarkers urinary tissue inhibitor of metalloproteinases (TIMP-2)insulin-like growth factor-binding protein 7 (IGFBP7) has shown the best predictive value for AKI in general ICU patients [5]. A subsequent study by our group in adult patients who underwent elective cardiac surgery demonstrated that in this specific setting, both uCHI3L1 and uNGAL showed inadequate predictive value for AKI [9]
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