Role of biomarkers for predicting acute kidney injury development, initiation of kidney replacement therapy, and prognosis in critically ill patients with COVID-19

Abstract

Purpose: To investigate whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary liver-type fatty acid-binding protein (uL-FABP) can predict acute kidney injury (AKI) complications, kidney replacement therapy (KRT) initiation, and prognosis of critically ill patients with COVID-19. Methods: This single-center, retrospective cohort study included 287 critically ill patients with COVID-19 admitted to our ICU. Based on median uNGAL and uL-FABP values measured at ICU admission, patients were divided into the following groups: the N-L (uNGAL ≤ 33.3 µg/gCr), N-H (> 33.3 µg/gCr), L-L (uL-FABP ≤ 59.7 µg/gCr), and LH (> 59.7 µg/gCr) groups. Statistical analysis of AKI incidence, KRT initiation, and 28- day mortality were performed. Results: AKI incidence was higher in the N-H and L-H groups than in the N-L (p<0.01) and L-L groups (p<0.01), respectively. KRT initiation was more frequent in the N-H group than in the N-L group (p<0.01); however, no significant difference was observed between the L-L and L-H groups (p=0.08). Twenty-eight-day mortality was higher in the N-H group than in the N-L group (Logrank p<0.01); however, no significant difference was observed between the L-L and L-H groups (Logrank p=0.52). Conclusions: While uNGAL and uL-FABP are useful in predicting AKI development, uNGAL may be more useful than uL-FABP in predicting outcomes, including KRT requirement and 28-day mortality in critically ill patients with COVID-19.