Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injury
The lack of early renal function recovery among geriatric patients with acute kidney injury (AKI) in the intensive care unit (ICU) is a commonly observed and acknowledged poor prognostic factor, especially for older adults. However, no reliable prognostic biomarker is available for identifying indiv...
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| Format: | Article |
| Language: | English |
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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.2024.2304099 |
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| author | Li Cheng Hui-Miao Jia Xi Zheng Yi-Jia Jiang Xin Xin Wen-Xiong Li |
| author_facet | Li Cheng Hui-Miao Jia Xi Zheng Yi-Jia Jiang Xin Xin Wen-Xiong Li |
| author_sort | Li Cheng |
| collection | DOAJ |
| description | The lack of early renal function recovery among geriatric patients with acute kidney injury (AKI) in the intensive care unit (ICU) is a commonly observed and acknowledged poor prognostic factor, especially for older adults. However, no reliable prognostic biomarker is available for identifying individuals at risk of renal non-recovery or mortality in older adults. In this prospective observational cohort study, we enrolled critically ill older adults (aged ≥ 60 years) with AKI from the ICU and followed their disease progression. The primary endpoint was renal non-recovery within seven days of follow-up, while the secondary endpoint was the determinants of 30-day mortality after AKI. We assessed the predictive accuracy using receiver operating characteristic curves and performed between-group comparisons using the log-rank test. Among 209 older adults, 117 (56.0%) experienced renal recovery. Multiple regression analysis revealed that urine levels of tissue inhibitor of metalloproteinase-2 (TIMP-2) multiplied by insulin-like growth factor-binding protein 7 (IGFBP7) ([TIMP-2]*[IGFBP7]), AKI stages 2–3, and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were independently associated with renal non-recovery. The regression model incorporating [TIMP-2]*[IGFBP7] demonstrated a fair predictive value (AUC 0.774, p < 0.001), with the optimal threshold set at 0.81 (ng/mL)2/1000. When [TIMP-2]*[IGFBP7] was combined with AKI severity and the APACHE score, the AUC increased to 0.851. In conclusion, urine [TIMP-2]*[IGFBP7] is a reliable biomarker associated with renal non-recovery in critically ill older adults, and its predictive efficacy can be further enhanced when combined with AKI severity and the APACHE score. |
| format | Article |
| id | doaj-art-aaa0756c363b419f90708e32ab5f02a9 |
| 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-aaa0756c363b419f90708e32ab5f02a92025-01-23T04:17:48ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492024-12-0146110.1080/0886022X.2024.2304099Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injuryLi Cheng0Hui-Miao Jia1Xi Zheng2Yi-Jia Jiang3Xin Xin4Wen-Xiong Li5Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, ChinaThe lack of early renal function recovery among geriatric patients with acute kidney injury (AKI) in the intensive care unit (ICU) is a commonly observed and acknowledged poor prognostic factor, especially for older adults. However, no reliable prognostic biomarker is available for identifying individuals at risk of renal non-recovery or mortality in older adults. In this prospective observational cohort study, we enrolled critically ill older adults (aged ≥ 60 years) with AKI from the ICU and followed their disease progression. The primary endpoint was renal non-recovery within seven days of follow-up, while the secondary endpoint was the determinants of 30-day mortality after AKI. We assessed the predictive accuracy using receiver operating characteristic curves and performed between-group comparisons using the log-rank test. Among 209 older adults, 117 (56.0%) experienced renal recovery. Multiple regression analysis revealed that urine levels of tissue inhibitor of metalloproteinase-2 (TIMP-2) multiplied by insulin-like growth factor-binding protein 7 (IGFBP7) ([TIMP-2]*[IGFBP7]), AKI stages 2–3, and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were independently associated with renal non-recovery. The regression model incorporating [TIMP-2]*[IGFBP7] demonstrated a fair predictive value (AUC 0.774, p < 0.001), with the optimal threshold set at 0.81 (ng/mL)2/1000. When [TIMP-2]*[IGFBP7] was combined with AKI severity and the APACHE score, the AUC increased to 0.851. In conclusion, urine [TIMP-2]*[IGFBP7] is a reliable biomarker associated with renal non-recovery in critically ill older adults, and its predictive efficacy can be further enhanced when combined with AKI severity and the APACHE score.https://www.tandfonline.com/doi/10.1080/0886022X.2024.2304099Acute kidney injurygeriatricsIGFBP7intensive care unit mortalityrenal recoveryTIMP-2 |
| spellingShingle | Li Cheng Hui-Miao Jia Xi Zheng Yi-Jia Jiang Xin Xin Wen-Xiong Li Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injury Renal Failure Acute kidney injury geriatrics IGFBP7 intensive care unit mortality renal recovery TIMP-2 |
| title | Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injury |
| title_full | Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injury |
| title_fullStr | Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injury |
| title_full_unstemmed | Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injury |
| title_short | Association between the levels of urinary cell cycle biomarkers and non-recovery of renal function among critically ill geriatric patients with acute kidney injury |
| title_sort | association between the levels of urinary cell cycle biomarkers and non recovery of renal function among critically ill geriatric patients with acute kidney injury |
| topic | Acute kidney injury geriatrics IGFBP7 intensive care unit mortality renal recovery TIMP-2 |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2304099 |
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