External validation of urinary C–C motif chemokine ligand 14 (CCL14) for prediction of persistent acute kidney injury

Critical Care

J. Patrick Kampf¹  Paul McPherson¹  Thomas Kwan¹  Antonio Artigas²  Danielle Davison³  Kai Zacharowski⁴  Ali Al-Khafaji⁵  John A. Kellum⁵  Sean M. Bagshaw⁶  Michael Haase⁷  Matthew Lissauer⁸  Lakhmir S. Chawla⁹ 

[1] Astute Medical, Inc. (a bioMérieux company), 3550 General Atomics Ct, 92121, San Diego, CA, USA;Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Parc Tauli 1, 08208, Sabadell, Spain;Department of Anesthesiology and Critical Care Medicine, School of Medicine and Health Sciences, George Washington University, 900 23rd St. NW, 20037, Washington, DC, USA;Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany;Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, 3550 Terrace St., Scaife Hall, Suite 600, 15213, Pittsburgh, PA, USA;Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 ST NW, T6G 2B7, Edmonton, AB, Canada;Diaverum Renal Care Center, 14469 Potsdam, Germany and Medical Faculty, Otto Von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany;Division of Acute Care Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Patterson Street, 07746, New Brunswick, NJ, USA;Veterans Affairs Medical Center, 3350 La Jolla Village Dr, 92161, San Diego, CA, USA;

关键词: Acute kidney injury;    Prediction;    Validation;    Renal replacement therapy;    Mortality;   

DOI  :  10.1186/s13054-021-03618-1

来源: Springer

【 摘 要 】

BackgroundPersistent acute kidney injury (AKI) portends worse clinical outcomes and remains a therapeutic challenge for clinicians. A recent study found that urinary C–C motif chemokine ligand 14 (CCL14) can predict the development of persistent AKI. We aimed to externally validate urinary CCL14 for the prediction of persistent AKI in critically ill patients.MethodsThis was a secondary analysis of the prospective multi-center SAPPHIRE study. We evaluated critically ill patients with cardiac and/or respiratory dysfunction who developed Kidney Disease: Improving Global Outcomes (KDIGO) stage 2–3 AKI within one week of enrollment. The main exposure was the urinary concentration of CCL14 measured at the onset of AKI stage 2–3. The primary endpoint was the development of persistent severe AKI, defined as  ≥ 72 h of KDIGO stage 3 AKI or death or renal-replacement therapy (RRT) prior to 72 h. The secondary endpoint was a composite of RRT and/or death by 90 days. We used receiver operating characteristic (ROC) curve analysis to assess discriminative ability of urinary CCL14 for the development of persistent severe AKI and multivariate analysis to compare tertiles of urinary CCL14 and outcomes.ResultsWe included 195 patients who developed KDIGO stage 2–3 AKI. Of these, 28 (14%) developed persistent severe AKI, of whom 15 had AKI  ≥ 72 h, 12 received RRT and 1 died prior to  ≥ 72 h of KDIGO stage 3 AKI. Persistent severe AKI was associated with chronic kidney disease, diabetes mellitus, higher non-renal APACHE III score, greater fluid balance, vasopressor use, and greater change in baseline serum creatinine. The AUC for urinary CCL14 to predict persistent severe AKI was 0.81 (95% CI, 0.72–0.89). The risk of persistent severe AKI increased with higher values of urinary CCL14. RRT and/or death at 90 days increased within tertiles of urinary CCL14 concentration.ConclusionsThis secondary analysis externally validates urinary CCL14 to predict persistent severe AKI in critically ill patients.

【 授权许可】

CC BY