Biomarkers and early-onset acute kidney injury in critically ill COVID-19 patients, a prospective monocentric observational study

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BACKGROUND: The present study evaluated the diagnostic and prognostic value of biomarkers, including soluble forms of the receptor for advanced glycation end-products (s-RAGE), soluble urokinase plasminogen activator receptor (SuPAR), and others, for the occurrence of early-onset acute kidney injury (EO-AKI), EO-AKI non-recovery, day-90 major adverse kidney events (MAKE-90), and day-90 mortality in critically ill patients with Coronavirus Disease-19 (Covid-19). METHODS: A single-center, prospective study was conducted at the University Hospital of Clermont-Ferrand, France, between March 2020 and February 2021. The study included adult patients suffering from severe pneumonia caused by the SARS-CoV-2 virus, who were admitted to the hospital's intensive care unit. The urinary biomarkers that constituted the focus of the study included SuPAR, liver fatty-acid-binding proteins (L-FABP), urinary tissue inhibitor of metalloprotease-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) ([TIMP-2]*[IGFBP7]). The serum biomarkers that were studied included s-RAGE and inflammatory markers such as interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α. Assessed outcomes included EO-AKI, EO-AKI non-recovery, MAKE-90, and day-90 mortality. A range of statistical methodologies were employed for the analysis. RESULTS: The study comprised a total of 149 patients. The prevalence of EO-AKI was found to be 30.9%. In 56.5% of cases, EO-AKI non-recovery occurred. MAKE-90 was 43.6% and day-90 mortality was 37%. Procalcitonin was found to be associated with EO-AKI, whilst TNF-α was associated with EO-AKI non-recovery. Furthermore, elevated levels of s-RAGE and SuPAR levels were found to be associated with MAKE-90. CONCLUSIONS: In critically ill patients with confirmed diagnosis of COVID-19, the presence of biomarkers had limited predictive value for the occurrence of EO-AKI. However, TNF-α was found to be associated with EO-AKI non-recovery and s-RAGE and SuPAR were associated with an increased risk of day-90 mortality. CLINICAL TRIAL NUMBER: Not applicable.

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