Urinary angiotensinogen predicts adverse outcomes among acute kidney injury patients in the intensive care unit

INTRODUCTION: Acute kidney injury (AKI) is commonly observed in the intensive care unit (ICU), where it can be caused by a variety of factors. The objective of this study was to evaluate the prognostic value of urinary angiotensinogen, a candidate prognostic AKI biomarker identified in post-cardiac surgery patients, in this heterogeneous population. METHODS: Urinary angiotensinogen was measured by ELISA and corrected for urine creatinine in 45 patients who developed AKI in the ICU. Patients were grouped by AKI etiology, and the angiotensinogen-to-creatinine ratio (uAnCR) was compared among the groups using the Kruskal-Wallis test. The ability of uAnCR to predict the following endpoints was tested using the area under the ROC curve (AUC): the need for renal replacement therapy (RRT) or death, increased length of stay (defined as hospital discharge>7 days or death≤7 days from sample collection), and worsening AKI (defined as an increase in serum creatinine>0.3 mg/dL after sample collection or RRT). RESULTS: uAnCR was significantly elevated in patients who met the composite outcome RRT or death (89.4 vs 25.4 ng/mg; P=0.01), and it was a strong predictor of this outcome (AUC=0.73). Patients with uAnCR values above the median for the cohort (55.21 ng/mg) had increased length of stay compared to patients with uAnCR≤55.21 ng/mg (22 days vs 7 days after sample collection; P=0.01). uAnCR was predictive of the outcome increased length of stay (AUC=0.77). uAnCR was also a strong predictor of worsening of AKI (AUC=0.77). The uAnCR of patients with pre-renal AKI was lower compared to patients with AKI of other causes (median uAnCR 11.3 vs 80.2 ng/mg; P=0.02). CONCLUSIONS: Elevated urinary angiotensinogen is associated with adverse events in AKI patients in the ICU. It could be used to identify high risk patients who would benefit from timely intervention that could improve their outcomes.