Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Mexico City 14080, Mexico.
Subdirección de Atención Médica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Mexico City 14080, Mexico.
Biomolecules. 2022 Feb 8;12(2):275. doi: 10.3390/biom12020275.
A high proportion of critically ill patients with COVID-19 develop acute kidney injury (AKI) and die. The early recognition of subclinical AKI could contribute to AKI prevention. Therefore, this study was aimed at exploring the role of the urinary biomarkers NGAL and [TIMP-2] × [IGFBP7] for the early detection of AKI in this population. This prospective, longitudinal cohort study included critically ill COVID-19 patients without AKI at study entry. Urine samples were collected on admission to critical care areas for determination of NGAL and [TIMP-2] × [IGFBP7] concentrations. The demographic information, comorbidities, clinical, and laboratory data were recorded. The study outcomes were the development of AKI and mortality during hospitalization. Of the 51 individuals that were studied, 25 developed AKI during hospitalization (49%). Of those, 12 had persistent AKI (23.5%). The risk factors for AKI were male gender (HR = 7.57, 95% CI: 1.28-44.8; = 0.026) and [TIMP-2] × [IGFBP7] ≥ 0.2 (ng/mL)/1000 (HR = 7.23, 95% CI: 0.99-52.4; = 0.050). Mortality during hospitalization was significantly higher in the group with AKI than in the group without AKI ( = 0.004). Persistent AKI was a risk factor for mortality (HR = 7.42, 95% CI: 1.04-53.04; = 0.046). AKI was frequent in critically ill COVID-19 patients. The combination of [TIMP-2] × [IGFBP7] together with clinical information, were useful for the identification of subclinical AKI in critically ill COVID-19 patients. The role of additional biomarkers and their possible combinations for detection of AKI in ritically ill COVID-19 patients remains to be explored in large clinical trials.
相当比例的 COVID-19 重症患者会发生急性肾损伤（AKI）并死亡。亚临床 AKI 的早期识别有助于预防 AKI。因此，本研究旨在探索尿生物标志物 NGAL 和 [TIMP-2]×[IGFBP7] 在该人群中早期检测 AKI 的作用。这项前瞻性、纵向队列研究纳入了研究入组时无 AKI 的 COVID-19 重症患者。入 ICU 时采集尿液样本，用于测定 NGAL 和 [TIMP-2]×[IGFBP7] 浓度。记录人口统计学信息、合并症、临床和实验室数据。研究结局为住院期间 AKI 的发生和死亡率。51 名研究对象中，25 名（49%）在住院期间发生 AKI，其中 12 名（23.5%）持续存在 AKI。AKI 的危险因素为男性（HR = 7.57，95%CI：1.28-44.8； = 0.026）和 [TIMP-2]×[IGFBP7]≥0.2（ng/mL)/1000（HR = 7.23，95%CI：0.99-52.4； = 0.050）。与无 AKI 组相比，AKI 组住院期间死亡率显著更高（ = 0.004）。持续性 AKI 是死亡的危险因素（HR = 7.42，95%CI：1.04-53.04； = 0.046）。COVID-19 重症患者 AKI 发生率较高。[TIMP-2]×[IGFBP7] 联合临床信息有助于识别 COVID-19 重症患者的亚临床 AKI。在大型临床试验中仍需进一步探索其他生物标志物及其组合在识别 COVID-19 重症患者 AKI 中的作用。
