Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy
AbstractTubular injury is the main cause of acute kidney injury (AKI) in critically ill COVID-19 patients. Proximal tubular dysfunction (PTD) and changes in urinary biomarkers, such as NGAL, TIMP-2, and IGFBP7 product ([TIMP-2]•[IGFBP7]), could precede AKI. We conducted a prospective cohort study fr...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Renal Failure |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2292152 |
| _version_ | 1797211837498916864 |
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| author | Romaric Larcher Anne-Sophie Bargnoux Stephanie Badiou Noemie Besnard Vincent Brunot Delphine Daubin Laura Platon Racim Benomar Matthieu Amalric Anne-Marie Dupuy Kada Klouche Jean-Paul Cristol |
| author_facet | Romaric Larcher Anne-Sophie Bargnoux Stephanie Badiou Noemie Besnard Vincent Brunot Delphine Daubin Laura Platon Racim Benomar Matthieu Amalric Anne-Marie Dupuy Kada Klouche Jean-Paul Cristol |
| author_sort | Romaric Larcher |
| collection | DOAJ |
| description | AbstractTubular injury is the main cause of acute kidney injury (AKI) in critically ill COVID-19 patients. Proximal tubular dysfunction (PTD) and changes in urinary biomarkers, such as NGAL, TIMP-2, and IGFBP7 product ([TIMP-2]•[IGFBP7]), could precede AKI. We conducted a prospective cohort study from 2020/03/09 to 2020/05/03, which consecutively included all COVID-19 patients who had at least one urinalysis, to assess the incidence of PTD and AKI, and the effectiveness of PTD, NGAL, and [TIMP-2]•[IGFBP7] in AKI and persistent AKI prediction using the area under the receiver operating characteristic curves (AUCs), Kaplan–Meier methodology (log-rank tests), and Cox models. Among the 60 patients admitted to the ICU with proven COVID-19 (median age: 63-year-old (interquartile range: IQR, 55–74), 45 males (75%), median simplified acute physiology score (SAPS) II: 34 (IQR, 22–47) and median BMI: 25.7 kg/m2 (IQR, 23.3–30.8)) analyzed, PTD was diagnosed in 29 patients (48%), AKI in 33 (55%) and persistent AKI in 20 (33%). Urinary NGAL had the highest AUC for AKI prediction: 0.635 (95%CI: 0.491–0.779) and persistent AKI prediction: 0.681 (95%CI: 0.535–0.826), as compared to PTD and [TIMP-2]•[IGFBP7] (AUCs <0.6). AKI was independently associated with higher SAPSII (HR = 1.04, 95%CI: 1.01–1.06, p = 0.005) and BMI (HR = 1.07, 95%CI: 1.00–1.14, p = 0.04) and persistent AKI with higher SAPSII (HR = 1.03, 95%CI: 1.00–1.06, p = 0.048) and nephrotoxic drug use (HR = 3.88, 95%CI: 1.20–12.5, p = 0.02). In conclusion, in critically ill COVID-19 patients, the incidence of PTD and AKI was relatively high. NGAL was the best urinary biomarker for predicting AKI, but only clinical severity was independently associated with its occurrence. |
| first_indexed | 2024-03-09T01:05:05Z |
| format | Article |
| id | doaj.art-ccda4949b9ca41aeb18b6d051d8262f7 |
| institution | Directory Open Access Journal |
| issn | 0886-022X 1525-6049 |
| language | English |
| last_indexed | 2024-04-24T10:32:50Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj.art-ccda4949b9ca41aeb18b6d051d8262f72024-04-12T14:34:28ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492023-12-0145210.1080/0886022X.2023.2292152Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathyRomaric Larcher0Anne-Sophie Bargnoux1Stephanie Badiou2Noemie Besnard3Vincent Brunot4Delphine Daubin5Laura Platon6Racim Benomar7Matthieu Amalric8Anne-Marie Dupuy9Kada Klouche10Jean-Paul Cristol11Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, FranceBiochemistry and Hormonology Department, Montpellier University Hospital, Montpellier, FranceBiochemistry and Hormonology Department, Montpellier University Hospital, Montpellier, FranceIntensive Care Medicine Department, Montpellier University Hospital, Montpellier, FranceIntensive Care Medicine Department, Montpellier University Hospital, Montpellier, FranceIntensive Care Medicine Department, Montpellier University Hospital, Montpellier, FranceIntensive Care Medicine Department, Montpellier University Hospital, Montpellier, FranceIntensive Care Medicine Department, Montpellier University Hospital, Montpellier, FranceIntensive Care Medicine Department, Montpellier University Hospital, Montpellier, FrancePhyMedExp Laboratory, INSERM, CNRS, Montpellier University, Montpellier, FranceIntensive Care Medicine Department, Montpellier University Hospital, Montpellier, FranceBiochemistry and Hormonology Department, Montpellier University Hospital, Montpellier, FranceAbstractTubular injury is the main cause of acute kidney injury (AKI) in critically ill COVID-19 patients. Proximal tubular dysfunction (PTD) and changes in urinary biomarkers, such as NGAL, TIMP-2, and IGFBP7 product ([TIMP-2]•[IGFBP7]), could precede AKI. We conducted a prospective cohort study from 2020/03/09 to 2020/05/03, which consecutively included all COVID-19 patients who had at least one urinalysis, to assess the incidence of PTD and AKI, and the effectiveness of PTD, NGAL, and [TIMP-2]•[IGFBP7] in AKI and persistent AKI prediction using the area under the receiver operating characteristic curves (AUCs), Kaplan–Meier methodology (log-rank tests), and Cox models. Among the 60 patients admitted to the ICU with proven COVID-19 (median age: 63-year-old (interquartile range: IQR, 55–74), 45 males (75%), median simplified acute physiology score (SAPS) II: 34 (IQR, 22–47) and median BMI: 25.7 kg/m2 (IQR, 23.3–30.8)) analyzed, PTD was diagnosed in 29 patients (48%), AKI in 33 (55%) and persistent AKI in 20 (33%). Urinary NGAL had the highest AUC for AKI prediction: 0.635 (95%CI: 0.491–0.779) and persistent AKI prediction: 0.681 (95%CI: 0.535–0.826), as compared to PTD and [TIMP-2]•[IGFBP7] (AUCs <0.6). AKI was independently associated with higher SAPSII (HR = 1.04, 95%CI: 1.01–1.06, p = 0.005) and BMI (HR = 1.07, 95%CI: 1.00–1.14, p = 0.04) and persistent AKI with higher SAPSII (HR = 1.03, 95%CI: 1.00–1.06, p = 0.048) and nephrotoxic drug use (HR = 3.88, 95%CI: 1.20–12.5, p = 0.02). In conclusion, in critically ill COVID-19 patients, the incidence of PTD and AKI was relatively high. NGAL was the best urinary biomarker for predicting AKI, but only clinical severity was independently associated with its occurrence.https://www.tandfonline.com/doi/10.1080/0886022X.2023.2292152NGALTIMP-2IGFBP7NephroCheckkidney proximal tubulopathyFanconi syndrome |
| spellingShingle | Romaric Larcher Anne-Sophie Bargnoux Stephanie Badiou Noemie Besnard Vincent Brunot Delphine Daubin Laura Platon Racim Benomar Matthieu Amalric Anne-Marie Dupuy Kada Klouche Jean-Paul Cristol Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy Renal Failure NGAL TIMP-2 IGFBP7 NephroCheck kidney proximal tubulopathy Fanconi syndrome |
| title | Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy |
| title_full | Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy |
| title_fullStr | Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy |
| title_full_unstemmed | Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy |
| title_short | Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy |
| title_sort | acute kidney injury in critical covid 19 patients usefulness of urinary biomarkers and kidney proximal tubulopathy |
| topic | NGAL TIMP-2 IGFBP7 NephroCheck kidney proximal tubulopathy Fanconi syndrome |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2292152 |
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