scholarly journals Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0003552020
Author(s):  
Alexander H. Flannery ◽  
Katherine Bosler ◽  
Victor M. Ortiz-Soriano ◽  
Fabiola Gianella ◽  
Victor Prado ◽  
...  
Keyword(s):  
Prediction Model ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Clinical Prediction ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Clinical Prediction Model ◽  
Major Adverse Kidney Events

Background: Several biomarkers of acute kidney injury (AKI) have been examined for their ability to predict AKI before serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research. Methods: Single-center prospective study collecting blood and urine samples from critically ill patients with AKI Kidney Disease: Improving Global Outcomes stage 2 or above, and matched controls from a single, tertiary care intensive care unit. Samples were collected at 24-48 hours after AKI diagnosis (cases) or ICU admission (controls), 5-7 days later, and 4-6 weeks following discharge for AKI patients. The primary outcome of interest was MAKE at hospital discharge (MAKE-DC), consisting of the composite endpoint of death, renal replacement therapy dependence, or a decrease in estimated glomerular filtration to <75% of baseline. Results: Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE-DC compared to those not experiencing MAKE-DC. Additionally, serum/urinary NGAL and serum cystatin C measurements at the first time point remained significantly associated with MAKE events at 3, 6, and 12 months. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a logistic regression clinical prediction model of MAKE-DC (AUROC 0.94 and 0.87 vs. 0.83; p= 0.001 and 0.019, respectively). Patients without MAKE-DC experienced a greater decline in serum NGAL from first to second measurement than those patients experiencing MAKE-DC. Conclusion: Early measures of kidney biomarkers in critically ill patients are associated with MAKE-DC. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE-DC.

scholarly journals Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients

2020 ◽  
Author(s):  
Alexander H. Flannery ◽  
Katherine Bosler ◽  
Victor Ortiz-Soriano ◽  
Fabiola Gianella ◽  
Victor Prado ◽  
...  
Keyword(s):  
Prediction Model ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Major Adverse Kidney Events

AbstractBackgroundSeveral biomarkers of acute kidney injury (AKI) have been examined for their ability to predict AKI earlier than serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research.MethodsSingle-center prospective study collecting blood and urine samples from critically ill patients with AKI KDIGO stage 2 or above, and matched controls from a single, tertiary care intensive care unit. Samples were collected at 24-48 hours after AKI diagnosis (cases) or ICU admission (controls), 5-7 days later, and 4-6 weeks following discharge for AKI patients. The primary outcome of interest was MAKE at hospital discharge.ResultsSerum/urinary neutrophil gelatinase-associated lipocalin, serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE compared to those not experiencing MAKE at hospital discharge. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a clinical prediction model of MAKE as assessed by the area under the receiver operating characteristic curve.Patients without MAKE experienced a greater decline in serum NGAL from initial measurement to second measurement than those patients experiencing MAKE.ConclusionEarly measures of kidney biomarkers in critically ill patients are associated with MAKE. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE.

scholarly journals Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Christopher J. Kirwan ◽  
Barbara J. Philips ◽  
Iain A. M. MacPhee
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Serum Cystatin C ◽  
Serum Cystatin

Introduction.RIFLE and AKIN provide a standardised classification of acute kidney injury (AKI), but their categorical rather than continuous nature restricts their use to a research tool. A more accurate real-time description of renal function in AKI is needed, and some published data suggest that equations based on serum creatinine that estimate glomerular filtration rate (eGFR) can provide this. In addition, incorporating serum cystatin C concentration into estimates of GFR may improve their accuracy, but no eGFR equations are validated in critically ill patients with AKI.Aim.This study tests whether creatinine or cystatin-C-based eGFR equations, used in patients with CKD, offer an accurate representation of 4-hour creatinine clearance (4CrCl) in critically ill patients with AKI.Methods.Fifty-one critically ill patients with AKI were recruited. Thirty-seven met inclusion criteria, and the performance of eGFR equations was compared to 4CrCl.Results.eGFR equations were better than creatinine alone at predicting 4CrCl. Adding cystatin C to estimates did not improve the bias or add accuracy. The MDRD 7 eGFR had the best combination of correlation, bias, percentage error and accuracy. None were near acceptable standards quoted in patients with chronic kidney disease (CKD).Conclusions.eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set.

scholarly journals Serum cystatin C is a poor biomarker for diagnosing acute kidney injury in critically-ill children

2013 ◽  
Vol 17 (2) ◽  
pp. 92-98 ◽  
Author(s):  
Hanan M. Hamed ◽  
Seham Awad El-Sherbini ◽  
Nahla A. Barakat ◽  
Tarek M. Farid ◽  
Enas Abdel Rasheed
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Cystatin C ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Serum Cystatin C ◽  
Serum Cystatin

Early detection of acute kidney injury by serum cystatin C in critically ill children

2013 ◽  
Vol 29 (1) ◽  
pp. 133-138 ◽  
Author(s):  
Neamatollah Ataei ◽  
Behnaz Bazargani ◽  
Sonbol Ameli ◽  
Abbas Madani ◽  
Faezeh Javadilarijani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Early Detection ◽  
Critically Ill ◽  
Cystatin C ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Serum Cystatin C ◽  
Serum Cystatin

scholarly journals Cystatin C and Iris: Advances in the Evaluation of Kidney Function in Critically Ill Dog

2021 ◽  
Vol 8 ◽  
Author(s):  
Fabiola de Oliveira Paes-Leme ◽  
Eliana M. Souza ◽  
Paulo Ricardo Oliveira Paes ◽  
Maderleine Geisa Gomes ◽  
Felipe Santos Muniz ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Urine Output ◽  
Kidney Injury ◽  
Serum Levels ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Daily Monitoring ◽  
Early Biomarker

Critically ill hospitalized dogs are subject to certain complications, being acute kidney injury (AKI) a common one. Early diagnosis is crucial, and Cystatin C (CysC) is a reliable and early biomarker. The International Society of Renal Interest (IRIS) states that AKI severity can be assessed by mild changes in creatinine serum levels or reduction of urine output that cannot be considered biomarkers of renal injury but failure or insufficiency. Twenty-eight dogs admitted to the Intensive Care Unit under risk factors for the development of AKI were evaluated. Blood samples were collected for determination of sCr and CysC at admission and after 24, 48, and 72 h. Urine output was measured by daily monitoring, measured by collection in a closed system. The results showed the incidence of AKI was 67.9% based on the IRIS criteria and 78.6% based on cystatin C in critically ill patients' dogs. The measurement of serum cystatin C immediately on admission to the ICU was superior in the early identification of patients with AKI when compared to the IRIS classification and serum creatinine in critically ill dogs.

scholarly journals Predictive value of serum cystatin C for risk of mortality in severe and critically ill patients with COVID-19

2020 ◽  
Vol 8 (20) ◽  
pp. 4726-4734
Author(s):  
Yan Li ◽  
Shuang Yang ◽  
Ding Peng ◽  
Hong-Ming Zhu ◽  
Bang-Yi Li ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Predictive Value ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Risk Of Mortality

Usefulness of serum cystatin C to determine the dose of vancomycin in critically ill patients

2010 ◽  
Vol 62 (7) ◽  
pp. 901-907 ◽  
Author(s):  
Akio Suzuki ◽  
Yoshinori Imanishi ◽  
Shiho Nakano ◽  
Takashi Niwa ◽  
Tomofumi Ohmori ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Serum Cystatin C ◽  
Serum Cystatin
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