Abstract
A high proportion of critically ill patients with COVID-19 develop acute kidney injury (AKI) and die. The early recognition of subclinical AKI could contribute to AKI prevention. Therefore, this study was aimed at exploring the role of the urinary biomarkers NGAL and [TIMP-2] × [IGFBP7] for the early detection of AKI in this population. This prospective, longitudinal cohort study included critically ill COVID-19 patients without AKI at study entry. Urine samples were collected on admission to critical care areas for determination of NGAL and [TIMP-2] × [IGFBP7] concentrations. The demographic information, comorbidities, clinical, and laboratory data were recorded. The study outcomes were the development of AKI and mortality during hospitalization. Of the 51 individuals that were studied, 25 developed AKI during hospitalization (49%). Of those, 12 had persistent AKI (23.5%). The risk factors for AKI were male gender (HR = 7.57, 95% CI: 1.28-44.8; p = 0.026) and [TIMP-2] × [IGFBP7] ≥ 0.2 (ng/mL) 2 /1000 (HR = 7.23, 95% CI: 0.99-52.4; p = 0.050). Mortality during hospitalization was significantly higher in the group with AKI than in the group without AKI ( p = 0.004). Persistent AKI was a risk factor for mortality (HR = 7.42, 95% CI: 1.04-53.04; p = 0.046). AKI was frequent in critically ill COVID-19 patients. The combination of [TIMP-2] × [IGFBP7] together with clinical information, were useful for the identification of subclinical AKI in critically ill COVID-19 patients. The role of additional biomarkers and their possible combinations for detection of AKI in ritically ill COVID-19 patients remains to be explored in large clinical trials.
Keywords: COVID-19; acute kidney injury; insulin like growth factor binding protein 7; neutrophil gelatinase-associated lipocalin; tissue inhibitor of metalloproteinases-2; urinary kidney stress biomarkers.
【저자키워드】 COVID-19, Acute kidney injury, Neutrophil gelatinase-associated lipocalin, insulin like growth factor binding protein 7, tissue inhibitor of metalloproteinases-2, urinary kidney stress biomarkers., 【초록키워드】 Biomarker, Biomarkers, Risk factors, Mortality, Stress, Hospitalization, neutrophil, Comorbidities, clinical trials, Gender, Acute kidney injury, risk factor, kidney, Protein, AKI, Critically ill, Early detection, male, persistent, information, insulin, Admission, critically ill patients, COVID-19 patients, binding, Combination, COVID-19 patient, critically ill COVID-19 patients, on admission, Tissue Inhibitor, Critically ill patient, 95% CI, individual, laboratory data, longitudinal cohort study, clinical information, growth factor, study outcomes, concentrations, IGFBP7, collected, develop, proportion, contribute, significantly higher, were recorded, acute kidney, critical care area, study outcome, with COVID-19, 【제목키워드】 Recognition, urinary, role, Ill, Subclinical,