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. 2024 Dec 14;11(1):e41252.
doi: 10.1016/j.heliyon.2024.e41252. eCollection 2025 Jan 15.

Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department

Sumin Baek  1   2   3 , Inwon Park  1   2   3 , Seonghye Kim  1 , Young Woo Um  1 , Hee Eun Kim  1 , Kyunghoon Lee  4   5 , Jae Hyuk Lee  1   2   3 , You Hwan Jo  1   2   3
Affiliations

Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department

Sumin Baek et al. Heliyon. .

Abstract

Background: Development of acute kidney injury (AKI) in patients with sepsis is associated with increased mortality, highlighting the importance of early detection and management. However, baseline creatinine or urine output measurements are required for AKI diagnosis, which can be challenging in emergency departments (EDs). We aimed to evaluate the association between urinary biomarkers and the AKI diagnosis or 30-day survival status in patients with sepsis in the ED.

Methods: This prospective observational study enrolled patients from a single ED. We enrolled adult patients presenting to the ED with symptoms suggestive of infection and an initial quick sequential organ failure assessment score ≥2. Initial urine samples were collected, and urinary biomarkers (dickkopf-3, soluble triggering receptor expressed on myeloid cells-1, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin (NGAL), and tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor binding protein-7 (IGFBP-7), and TIMP-2 × IGFBP-7) were analyzed using an enzyme-linked immunosorbent assay kit. Multivariable logistic regression models were used to evaluate biomarker performance.

Results: Of 84 patients, 63 (75.0 %) were diagnosed with AKI and 16 (19.0 %) died within 30 days. None of the urinary biomarkers demonstrated significant differences between the survivors and non-survivors. NGAL (p = 0.014) and TIMP-2 × IGFBP-7 (p = 0.027) levels were different between the AKI and non-AKI groups. The multivariable logistic regression model suggested a higher area under the receiver operating characteristic curve for models, including TIMP-2 × IGFBP-7 (from 0.853 to 0.889, p = 0.018).

Conclusion: None of the urinary biomarkers in the initial urine sample demonstrated an independent association with AKI diagnosis or 30-day survival status in patients with sepsis presenting to the ED. Further studies with larger population are necessary to confirm its clinical utility and explore its role.

Keywords: Acute kidney injury; Biomarkers; Emergency service; Hospital; Insulin-like growth factor binding proteins; Sepsis; Tissue inhibitor of Metalloproteinase-2.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Inwon Park reports financial support was provided by 10.13039/501100003725National Research Foundation (NRF) of Korea. Inwon Park reports financial support was provided by Korea Health Industry Development Institute (KHIDI). Inwon Park reports financial support was provided by Seoul 10.13039/100018366National University 10.13039/100008212College of Medicine. Inwon Park reports financial support was provided by Seoul 10.13039/100018366National University Bundang Hospital. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

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Fig. 1
Flow chart of study population.
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References

    1. Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315(8):801–810. - PMC - PubMed
    1. Kim J., Kim K., Lee H., Ahn S. Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis. Clin Exp Emerg Med. 2019;6(1):49–63. - PMC - PubMed
    1. Zarbock A., Nadim M.K., Pickkers P., Gomez H., Bell S., Joannidis M., et al. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat. Rev. Nephrol. 2023;19(6):401–417. - PubMed
    1. Peerapornratana S., Manrique-Caballero C.L., Gomez H., Kellum J.A. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019;96(5):1083–1099. - PMC - PubMed
    1. Evans L., Rhodes A., Alhazzani W., Antonelli M., Coopersmith C.M., French C., et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit. Care Med. 2021;49(11):e1063–e1143. - PubMed

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