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- Development and validation of quick Acute Kidney Injury-score (q-AKI) to predict acute kidney injury at admission to a multidisciplinary intensive care unitPublication . Ferrari, Fiorenza; Puci, Mariangela Valentina; Ferraro, Ottavia Eleonora; Romero-González, Gregorio; Husain-Syed, Faeq; Rizo-Topete, Lilia; Senzolo, Mara; Lorenzin, Anna; Muraro, Eva; Baracca, Antonio; Serrano-Soto, Mara; Molano Triviño, Alejandra; Castro, Ana; De Cal, Massimo; Corradi, Valentina; Brendolan, Alessandra; Scarpa, Marta; Carta, Maria Rosa; Giavarina, Davide; Bonato, Raffaele; Iotti, Giorgio Antonio; Ronco, ClaudioAKI is associated with increased risk of death, prolonged length of stay and development of de-novo chronic kidney disease. The aim of our study is the development and validation of prediction models to identify the risk of AKI in ICU patients up to 7 days. We retrospectively recruited 692 consecutive patients admitted to the ICU at San Bortolo Hospital (Vicenza, Italy) from 1 June 2016 to 31 March 2017: 455 patients were treated as the derivation group and 237 as the validation group. Candidate variables were selected based on a literature review and expert opinion. Admission eGFR< 90 ml/min /1.73 mq (OR 2.78; 95% CI 1.78-4.35; p<0.001); SOFAcv ≥ 2 (OR 2.23; 95% CI 1.48-3.37; p<0.001); lactate ≥ 2 mmol/L (OR 1.81; 95% CI 1.19-2.74; p = 0.005) and (TIMP-2)•(IGFBP7) ≥ 0.3 (OR 1.65; 95% CI 1.08-2.52; p = 0.019) were significantly associated with AKI. For the q-AKI score, we stratified patients into different AKI Risk score levels: 0-2; 3-4; 5-6; 7-8 and 9-10. In both cohorts, we observed that the proportion of AKI patients was higher in the higher score levels.
- Routine Adoption of Urinary [IGFBP7]∙[TIMP-2] to Assess Acute Kidney Injury at Any Stage 12 hours After Intensive Care Unit Admission: a Prospective Cohort StudyPublication . Ferrari, Fiorenza; Romero-González, Gregorio; Topete, Lilia Rizo; Senzolo, Mara; Lorenzin, Anna; Husain-Syed, Faeq; Puci, Mariangela Valentina; Ferraro, Ottavia Eleonora; Muraro, Eva; Serrano-Soto, Mara; Triviño, Alejandra Molano; Castro, Ana; Xie, Yun; Yang, Bo; De Cal, Massimo; Corradi, Valentina; Brendolan, Alessandra; Scarpa, Marta; Carta, Maria Rosa; Giavarina, Davide; Bonato, Raffaele; Ronco, ClaudioThe urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 ([TIMP-2]∙[IGFBP7]) have been introduced to improve risk prediction of severe acute kidney injury (AKI) within 12 hours of measurement. We performed a prospective cohort study to evaluate if the predictive value of [TIMP-2]∙[IGFBP7] for AKI might continue after 12 hours. We enrolled 442 critically ill adult patients from June to December 2016. Urine samples were collected at admission for [TIMP-2]∙[IGFBP7] measurement. Baseline patient characteristics were recorded including patients' demographics, prior health history, and the main reason for admission to build a logistic regression model to predict AKI. AKI occurrence differed between patients with [TIMP-2]∙[IGFBP7] ≤0.3 and >0.3 (ng/ml)2/1000 (31.9% and 68.10% respectively; p < 0.001). Patients with AKI had higher biomarker values compared to those without AKI (0.66 (0.21-2.84) vs 0.22 (0.08-0.63) (ng/ml)2/1000; p < 0.001). [TIMP-2]∙[IGFBP7] at ICU admission had a lower performance in predicting AKI at any stage within 48 hours and 7 days after measurement (area under the receiver operating characteristic curve (AUC) equal to 0.70 (95%CI 0.65-0.76), AUC 0.68 (95%CI 0.63-0.73)). In the logistic regression model, 0.1 (ng/ml)2/1000-unit increment was likely to increase the risk of AKI by 2% (p = 0.002).