Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department
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 em...
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Elsevier
2025-01-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024172830 |
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| author | Sumin Baek Inwon Park Seonghye Kim Young Woo Um Hee Eun Kim Kyunghoon Lee Jae Hyuk Lee You Hwan Jo |
| author_facet | Sumin Baek Inwon Park Seonghye Kim Young Woo Um Hee Eun Kim Kyunghoon Lee Jae Hyuk Lee You Hwan Jo |
| author_sort | Sumin Baek |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-518cc9e5688541e6b98d26f64045576d |
| institution | Kabale University |
| issn | 2405-8440 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj-art-518cc9e5688541e6b98d26f64045576d2025-01-17T04:50:39ZengElsevierHeliyon2405-84402025-01-01111e41252Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency departmentSumin Baek0Inwon Park1Seonghye Kim2Young Woo Um3Hee Eun Kim4Kyunghoon Lee5Jae Hyuk Lee6You Hwan Jo7Department of Emergency Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South KoreaDepartment of Emergency Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea; Corresponding author. Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.Department of Emergency Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South KoreaDepartment of Emergency Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South KoreaDepartment of Emergency Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South KoreaDepartment of Laboratory Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South KoreaDepartment of Emergency Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South KoreaDepartment of Emergency Medicine, Seoul National University Bundang Hospital (SNUBH), Seongnam-si, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South KoreaBackground: 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.http://www.sciencedirect.com/science/article/pii/S2405844024172830SepsisEmergency serviceHospitalAcute kidney injuryBiomarkersTissue inhibitor of Metalloproteinase-2 |
| spellingShingle | Sumin Baek Inwon Park Seonghye Kim Young Woo Um Hee Eun Kim Kyunghoon Lee Jae Hyuk Lee You Hwan Jo Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department Heliyon Sepsis Emergency service Hospital Acute kidney injury Biomarkers Tissue inhibitor of Metalloproteinase-2 |
| title | Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department |
| title_full | Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department |
| title_fullStr | Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department |
| title_full_unstemmed | Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department |
| title_short | Urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department |
| title_sort | urinary biomarkers for diagnosing acute kidney injury in sepsis in the emergency department |
| topic | Sepsis Emergency service Hospital Acute kidney injury Biomarkers Tissue inhibitor of Metalloproteinase-2 |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024172830 |
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