The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study)
Background The severity and course of sepsis-associated acute kidney injury (SA-AKI) are correlated with the mortality rate. Early detection of SA-AKI subphenotypes might facilitate the rapid provision of individualized care.Patients and methods In this post-hoc analysis of a multicenter prospective...
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Taylor & Francis Group
2024-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2325640 |
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| author | Dimitri Titeca-Beauport Momar Diouf Delphine Daubin Ly Van Vong Guillaume Belliard Cédric Bruel Yoann Zerbib Christophe Vinsonneau Kada Klouche Julien Maizel |
| author_facet | Dimitri Titeca-Beauport Momar Diouf Delphine Daubin Ly Van Vong Guillaume Belliard Cédric Bruel Yoann Zerbib Christophe Vinsonneau Kada Klouche Julien Maizel |
| author_sort | Dimitri Titeca-Beauport |
| collection | DOAJ |
| description | Background The severity and course of sepsis-associated acute kidney injury (SA-AKI) are correlated with the mortality rate. Early detection of SA-AKI subphenotypes might facilitate the rapid provision of individualized care.Patients and methods In this post-hoc analysis of a multicenter prospective study, we combined conventional kidney function variables with serial measurements of urine (tissue inhibitor of metalloproteinase-2 [TIMP-2])* (insulin-like growth factor-binding protein [IGFBP7]) at 0, 6, 12, and 24 h) and then using an unsupervised hierarchical clustering of principal components (HCPC) approach to identify different phenotypes of SA-AKI. We then compared the subphenotypes with regard to a composite outcome of in-hospital death or the initiation of renal replacement therapy (RRT).Results We included 184 patients presenting SA-AKI within 6 h of the initiation of catecholamines. Three distinct subphenotypes were identified: subphenotype A (99 patients) was characterized by a normal urine output (UO), a low SCr and a low [TIMP-2]*[IGFBP7] level; subphenotype B (74 patients) was characterized by existing chronic kidney disease (CKD), a higher SCr, a low UO, and an intermediate [TIMP-2]*[IGFBP7] level; and subphenotype C was characterized by very low UO, a very high [TIMP-2]*[IGFBP7] level, and an intermediate SCr level. With subphenotype A as the reference, the adjusted hazard ratio (aHR) [95%CI] for the composite outcome was 3.77 [1.92–7.42] (p < 0.001) for subphenotype B and 4.80 [1.67–13.82] (p = 0.004) for subphenotype C.Conclusions Combining conventional kidney function variables with urine measurements of [TIMP-2]*[IGFBP7] might help to identify distinct SA-AKI subphenotypes with different short-term courses and survival rates. |
| format | Article |
| id | doaj-art-85d4c29720a8448c8482917b62ba8a92 |
| institution | Kabale University |
| issn | 0886-022X 1525-6049 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj-art-85d4c29720a8448c8482917b62ba8a922025-01-23T04:17:49ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492024-12-0146110.1080/0886022X.2024.2325640The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study)Dimitri Titeca-Beauport0Momar Diouf1Delphine Daubin2Ly Van Vong3Guillaume Belliard4Cédric Bruel5Yoann Zerbib6Christophe Vinsonneau7Kada Klouche8Julien Maizel9Medical Intensive Care Unit and EA7517, Boreal Study Group, Amiens University Hospital, Amiens, FranceDepartment of Statistics, Amiens University Hospital, Amiens, FranceDepartment of Intensive Care Medicine, Lapeyronie University Hospital, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, FranceIntensive Care Unit, Groupe Hospitalier Sud Ile de France, Melun, FranceMedical-Surgical Intensive Care Unit, Centre Hospitalier de Bretagne Sud, Lorient, FranceMedical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, FranceMedical Intensive Care Unit and EA7517, Boreal Study Group, Amiens University Hospital, Amiens, FranceIntensive Care Unit, Boreal Study Group, Hôpital de Bethune, Bethune, FranceDepartment of Intensive Care Medicine, Lapeyronie University Hospital, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, FranceMedical Intensive Care Unit and EA7517, Boreal Study Group, Amiens University Hospital, Amiens, FranceBackground The severity and course of sepsis-associated acute kidney injury (SA-AKI) are correlated with the mortality rate. Early detection of SA-AKI subphenotypes might facilitate the rapid provision of individualized care.Patients and methods In this post-hoc analysis of a multicenter prospective study, we combined conventional kidney function variables with serial measurements of urine (tissue inhibitor of metalloproteinase-2 [TIMP-2])* (insulin-like growth factor-binding protein [IGFBP7]) at 0, 6, 12, and 24 h) and then using an unsupervised hierarchical clustering of principal components (HCPC) approach to identify different phenotypes of SA-AKI. We then compared the subphenotypes with regard to a composite outcome of in-hospital death or the initiation of renal replacement therapy (RRT).Results We included 184 patients presenting SA-AKI within 6 h of the initiation of catecholamines. Three distinct subphenotypes were identified: subphenotype A (99 patients) was characterized by a normal urine output (UO), a low SCr and a low [TIMP-2]*[IGFBP7] level; subphenotype B (74 patients) was characterized by existing chronic kidney disease (CKD), a higher SCr, a low UO, and an intermediate [TIMP-2]*[IGFBP7] level; and subphenotype C was characterized by very low UO, a very high [TIMP-2]*[IGFBP7] level, and an intermediate SCr level. With subphenotype A as the reference, the adjusted hazard ratio (aHR) [95%CI] for the composite outcome was 3.77 [1.92–7.42] (p < 0.001) for subphenotype B and 4.80 [1.67–13.82] (p = 0.004) for subphenotype C.Conclusions Combining conventional kidney function variables with urine measurements of [TIMP-2]*[IGFBP7] might help to identify distinct SA-AKI subphenotypes with different short-term courses and survival rates.https://www.tandfonline.com/doi/10.1080/0886022X.2024.2325640The AKI-CHECK study was registered at ClinicalTrials.gov (NCT02812784)Acute kidney injuryseptic shockbiomarkersphenotypecluster |
| spellingShingle | Dimitri Titeca-Beauport Momar Diouf Delphine Daubin Ly Van Vong Guillaume Belliard Cédric Bruel Yoann Zerbib Christophe Vinsonneau Kada Klouche Julien Maizel The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study) Renal Failure The AKI-CHECK study was registered at ClinicalTrials.gov (NCT02812784) Acute kidney injury septic shock biomarkers phenotype cluster |
| title | The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study) |
| title_full | The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study) |
| title_fullStr | The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study) |
| title_full_unstemmed | The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study) |
| title_short | The combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis-associated acute kidney injury: a post-hoc analysis (the PHENAKI study) |
| title_sort | combination of kidney function variables with cell cycle arrest biomarkers identifies distinct subphenotypes of sepsis associated acute kidney injury a post hoc analysis the phenaki study |
| topic | The AKI-CHECK study was registered at ClinicalTrials.gov (NCT02812784) Acute kidney injury septic shock biomarkers phenotype cluster |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2325640 |
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