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Comparative Performance of Novel and Standard Urinary Kidney Biomarkers for Prediction of Persistent Severe Acute Kidney Injury and Long-Term Major Adverse Kidney Events
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DOI：10.1159/000550218.png)
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Abstract
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Introduction: Acute kidney injury (AKI) is common complication in the critically ill. Standard functional biomarkers are limited at predicting persistent severe AKI (PS-AKI) and long-term outcomes. This study evaluated the diagnostic and prognostic performance of a panel of urinary biomarkers (novel and standard) for predicting PS-AKI and major adverse kidney events (MAKEs). Methods: This was an exploratory post hoc analysis of the prospective Dublin Acute Biomarker Group Evaluation (DAMAGE) multicentred prospective observational cohort study. ICU AKI (KDIGO stages 1-3) patients were included. Sixteen urinary biomarkers were measured on the day of AKI diagnosis. The primary endpoint was PS-AKI (stage 2/3 AKI >= 48 h). Discrimination was assessed using AUC and logistic regression models, and reclassification metrics (IDI, cfNRI). Secondary endpoints included MAKE90 and MAKE365. Tertile trends for CCL14 also evaluated. Results: Among 186 patients with AKI, 80 (43.0%) developed PS-AKI. Albumin (uAlb; AUC = 0.82; 95% CI: 0.76-0.88), albumin/creatinine ratio (uAlb/Cr; AUC = 0.79; 95% CI: 0.72-0.85), urine output (AUC = 0.81; 95% CI: 0.74-0.87), and serum creatinine (AUC = 0.77; 95% CI: 0.70-0.84) demonstrated the highest discrimination. In logistic regression analysis adjusted for a clinical model, IL-18 showed the strongest association with PS-AKI (aOR = 3.09; 95% CI: 1.92-5.30), while uAlb, uAlb/Cr, cystatin C, CCL14, and MCP-1 were also significantly associated. CCL14 and uAlb tertiles showed a significant stepwise increase in PS-AKI. uAlb was the strongest discriminator for MAKE90 (AUC = 0.70; 95% CI: 0.57-0.83). Pi-GST was negatively associated with MAKE365 (aOR = 0.44; 95% CI: 0.21-0.81). Conclusion: Urine output, uAlb, and uAlb/Cr outperformed several novel biomarkers and demonstrated strong discrimination for PS-AKI. CCL14 showed moderate discrimination and was associated with early adverse outcomes. These findings support integrating standard and novel biomarkers to personalise AKI management.
Keywords:
Biomarker
Persistent severe acute kidney injury
Albumin
C-C motif chemokine ligand-14
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