Elsayed Mohamed Mamdouh, Eldeeb Ahmed Elsayed, Tahoun Mona Moustafa, El-Wakil Hala Saddik, Naga Salah Said
Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Clinical and Chemical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
BMC Nephrol. 2025 Apr 17;26(1):195. doi: 10.1186/s12882-025-04096-1.
Sepsis associated acute kidney injury (SA-AKI) among hospitalized patients is common with higher morbidity and mortality. There is a need to discover new methods that allow better prediction of its outcomes and prognosis. We aimed to evaluate if combining serial examination of urine sediment to renal cell damage (KIM-1) and arrest (TIMP-2, IGFBP7) biomarkers could improve the prediction of progression and mortality of SA-AKI.
This prospective study enrolled 96 patients with stage 1 or 2 SA-AKI. Measuring of urinary TIMP-2, IGFBP7 and KIM-1 was done at time of AKI diagnosis and examination of urine sediment was performed by calculating Chawla score (CS) and Perazella score (PS) at days 1, 3 and 7. Main study outcomes included AKI progression to stage 3 and mortality.
Ninety-six patients were included in the study. 48% of them progressed to AKI stage 3 and 33.3% died. uTIMP2IGFBP7 and uKIM-1 showed an area under the curve (AUC) of 0.837 and 0.657 respectively for predicting AKI progression and an AUC of 0.679 and 0.626 respectively for predicting mortality. Combining urine sediment examination at day 3 (P2 and C2) to uTIMP2IGFBP7, uKIM-1 and both biomarkers significantly improved their prediction ability to an AUC of to 0.977, 0.951 and 0.979 respectively to predict AKI progression, and to an AUC of 0.807, 0.796 and 0.803 respectively to predict mortality.
Combining urine sediment examination with renal cell damage and arrest biomarkers significantly improved their performance of predicting AKI progression and mortality in patients with SA-AKI.
ClinicalTrials.gov Identifier: NCT06064487. First registration date: 21/09/2023.
住院患者中，脓毒症相关急性肾损伤（SA-AKI）很常见，其发病率和死亡率较高。需要发现能够更好预测其结局和预后的新方法。我们旨在评估将尿沉渣检查与肾细胞损伤（KIM-1）及阻滞（TIMP-2、IGFBP7）生物标志物的系列检测相结合，是否能改善对SA-AKI进展和死亡率的预测。
这项前瞻性研究纳入了96例1期或2期SA-AKI患者。在急性肾损伤诊断时检测尿TIMP-2、IGFBP7和KIM-1，并在第1、3和7天通过计算查拉评分（CS）和佩拉泽拉评分（PS）来进行尿沉渣检查。主要研究结局包括急性肾损伤进展至3期和死亡率。
96例患者纳入研究。其中48%进展至急性肾损伤3期，33.3%死亡。尿TIMP2IGFBP7和尿KIM-1预测急性肾损伤进展的曲线下面积（AUC）分别为0.837和0.657，预测死亡率的AUC分别为0.679和0.626。将第3天的尿沉渣检查（P2和C2）与尿TIMP2IGFBP7、尿KIM-1及两种生物标志物相结合，显著提高了它们的预测能力，预测急性肾损伤进展的AUC分别提高至0.977、0.951和0.979，预测死亡率的AUC分别提高至0.807、0.796和0.803。
将尿沉渣检查与肾细胞损伤及阻滞生物标志物相结合，显著提高了它们对SA-AKI患者急性肾损伤进展和死亡率的预测性能。
ClinicalTrials.gov标识符：NCT06064487。首次注册日期：2023年9月21日。
