What does this research mean for the field?

Standardized cutoffs of 1.3 ng/ml and 13 ng/ml for urinary CCL14 using a clinical assay can accurately identify patients at high risk for persistent severe acute kidney injury, need for renal replacement therapy, or death. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 25, 2022Open Access

Performance of a Standardized Clinical Assay for Urinary C–C Motif Chemokine Ligand 14 (CCL14) for Persistent Severe Acute Kidney Injury

JKJay L. KoynerUniversity of Chicago LCLakhmir S. ChawlaSan Francisco VA Medical Center ABAzra BihoracTwitter (United States)

Structured PICO

Does urinary CCL14 concentration predict the development of persistent severe AKI in adult ICU patients with established KDIGO stages 2-3 AKI?

Population

335 adult ICU patients with established KDIGO stages 2-3 AKI, median age 64, 62% male, multinational (21 sites in Europe and the United States). Excluded: prior kidney transplant, receiving or in imminent need of RRT, receiving comfort measures only, or known infection with HIV or active hepatitis.

Intervention

Measurement of urinary C-C motif chemokine ligand 14 (CCL14) using the NEPHROCLEAR CCL14 standardized clinical assay to stratify risk using cutoffs of 1.3 ng/ml and 13 ng/ml.

Comparator

Patients with lower urinary CCL14 concentrations (≤1.3 ng/ml).

Outcome

Persistent severe AKI, defined as KDIGO stage 3 AKI for at least 72 consecutive hours (patients who received RRT or died before achieving 72 hours in stage 3 AKI were also considered end point positive).composite

Standardized urinary CCL14 cutoffs of 1.3 and 13 ng/ml successfully identify ICU patients with established AKI who are at high risk for developing persistent severe AKI, RRT, or death.

Abstract

Key Points Using a standardized assay, we provide operating characteristics for two cutoffs for urinary C-C motif chemokine ligand 14 (CCL14) for the prediction of persistent severe AKI. A CCL14 cutoff of 1.3 ng/ml identifies 91% of patients who developed persistent severe AKI, need for RRT, or death, with a negative predictive value of 92%. In multivariable analyses, a CCL14 >13 ng/ml was associated with 10.4 adjusted odds for persistent severe AKI, need for RRT, or death ( P 13 ng/ml had an aOR of 10.4 (95% CI, 3.89 to 29.9; P <0.001). Conclusions Using a clinical assay, these standardized cutoffs (1.3 and 13 ng/ml) allow for the identification of patients at high risk for the development of persistent severe AKI. These results have immediate utility in helping to guide AKI patient care and may facilitate future clinical trials. Clinical Trial registry name and registration number: Identification and Validation of Biomarkers of Acute Kidney Injury Recovery, NCT01868724

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Cite This Study

Koyner et al. (Fri,) studied this question.

synapsesocial.com/papers/6a1e6b8246847b7f9c326a81 https://doi.org/https://doi.org/10.34067/kid.0008002021

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