Serial Urinary C-C Motif Chemokine Ligand 14 and Risk of Persistent Severe Acute Kidney Injury. (1st March 2023)

• Record Type: Journal Article
• Authors: Prowle, John R.; Artigas, Antonio; Bagshaw, Sean M.; Forni, Lui G.; Heung, Michael; Hoste, Eric; Marlies, Ostermann; Koyner, Jay L.; Chawla, Lakmir; Kampf, J. Patrick; Kwan, Thomas; McPherson, Paul; Kellum, John A.
• Other Names: Kashani K author non-byline.; Al-Khafaji A author non-byline.; Ardiles T author non-byline.; Artigas A author non-byline.; Bagshaw SM author non-byline.; Bell M author non-byline.; Bihorac A author non-byline.; Birkhahn R author non-byline.; Cely CM author non-byline.; Chawla LS author non-byline.; Davison D author non-byline.; Feldkamp T author non-byline.; Forni LG author non-byline.; Gong MN author non-byline.; Gunnerson KJ author non-byline.; Haase M author non-byline.; Hackett J author non-byline.; Honore P author non-byline.; Hoste EAJ author non-byline.; Joannes-Boyau O author non-byline.; Joannidis M author non-byline.; Kim P author non-byline.; Koyner JL author non-byline.; Laskowitz DT author non-byline.; Lissauer ME author non-byline.; Marx G author non-byline.; McCullough PA author non-byline.; Mullaney S author non-byline.; Ostermann M author non-byline.; Rimmele T author non-byline.; Shapiro NI author non-byline.; Shaw AD author non-byline.; Shi J author non-byline.; Walker MG author non-byline.; Sprague AM author non-byline.; Vincent JL author non-byline.; Vinsonneau C author non-byline.; Wagner L author non-byline.; Wilkerson RG author non-byline.; Zacharowski K author non-byline.; Kellum JA author non-byline.; Hoste Eric author non-byline.; Bihora Azra author non-byline.; Al-Khafaji Ali author non-byline.; Ortega Luis M. author non-byline.; Ostermann Marlies author non-byline.; Haase Michael author non-byline.; Zacharowski Kai author non-byline.; Wunderink Richard author non-byline.; Heung Michael author non-byline.; Gunnerson Kyle author non-byline.; Lissauer Matthew author non-byline.; Herr Daniel author non-byline.; Self Wesley H. author non-byline.; Koyner Jay L. author non-byline.; Honore Patrick M. author non-byline.; Prowle John R. author non-byline.; Davison Danielle author non-byline.; Artigas Antonio author non-byline.; Joannidis Michael author non-byline.; Schroeder Rebecca author non-byline.; Demirjian Sevag author non-byline.; Forni Lui G. author non-byline.; Hodgson Luke author non-byline.; Wilber Scott T. author non-byline.; Frey Jennifer A. author non-byline.; Reilly Ian author non-byline.; Shi Jing author non-byline.; Patrick Kampf J. author non-byline.; Kwan Thomas author non-byline.; McPherson Paul author non-byline.; Kellum John A. author non-byline.; Chawla Lakhmir S. author non-byline.;
• Is Part Of: Critical care explorations. Volume 5:Number 3(2023)
• Page Start: e0870
• Publication Date: 2023-03-01
• Subjects: acute kidney injury -- biomarkers -- C-C motif chemokine ligand 14 -- critical illness -- prognosis
• DOI: 10.1097/CCE.0000000000000870
• Languages: English
• ISSNs: 2639-8028

Abstract

Abstract : OBJECTIVES: To assess the added prognostic value of serial monitoring of urinary C-C motif chemokine ligand 14 (uCCL14) over that of single measurements, which have been shown to be prognostic for development of persistent severe acute kidney injury (AKI) in critically ill patients. DESIGN: Retrospective observational study. SETTING: Data derived from two multinational ICU studies (Ruby and Sapphire). PATIENTS: Critically ill patients with early stage 2–3 AKI. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed three consecutive uCCL14 measurements at 12-hour intervals after diagnosis of stage 2–3 AKI by Kidney Disease Improving Global Outcomes criteria. Primary outcome was persistent severe AKI, defined as 72 consecutive hours of stage 3 AKI, death, or receipt of dialysis prior to 72 hours. uCCL14 was measured using the NEPHROCLEAR uCCL14 Test on the Astute 140 Meter (Astute Medical, San Diego, CA). Based on predefined, validated cutoffs, we categorized uCCL14 as: low (≤ 1.3 ng/mL), medium (> 1.3 to ≤ 13 ng/mL), or high (> 13 ng/mL). Seventy-five of 417 patients with three consecutive uCCL14 measurements developed persistent severe AKI. Initial uCCL14 category strongly correlated with primary endpoint and, in most cases (66%), uCCL14 category was unchanged over the first 24 hours. Compared with no change and accounting for baseline category, decrease in category was associated with decreased odds of persistent severe AKI (odds ratio [OR], 0.20; 95% CI, 0.08–0.45; p < 0.001) and an increase in category with increased odds (OR, 4.04; 95% CI, 1.75–9.46; p = 0.001). CONCLUSIONS: In one-third of patients with moderate to severe AKI uCCL14 risk category altered over three serial measurements and such changes were associated with altered risk for persistent severe AKI. Serial CCL-14 measurement may detect progression or resolution of underlying kidney pathology and help refine AKI prognosis.