Serial Markers of Endothelial Dysfunction Are Associated with Acute Kidney Injury in a Population of Severe Trauma Patients
Year: 2021
Type: conference-abstract
Abstract: Background: Acute kidney injury (AKI) is common in the ICU and associated with morbidity and mortality.Markers of endothelial injury, including angiopoietin-2 (ang-2) and soluble thrombomodulin (sTM), are associated with AKI in sepsis.We sought to identify associations with risk for AKI after major trauma, where timing from injury to outcome can be accurately ascertained.Methods: We performed a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial, which compared 1:1:1 to 1:1:2 (plasma: platelets: RBC) transfusion ratios in severe trauma patients.We included patients with plasma collected at randomization who did not have AKI on presentation and did not die within 24 hours of presentation.Our primary outcome was AKI within 7 days of enrollment, defined as an increase from baseline of ≥ 0.3 mg/dL in 48 hours and/or ≥ 50% in serum creatinine in 7 days or need for new dialysis.Plasma biomarkers were log2 transformed, and relative-risk (RR) regression was performed to test associations between AKI and biomarker concentrations adjusting for age, sex, and injury severity score (ISS).We compared biomarkers between subjects with and without AKI at four time points (0 =h, 24h, 48h, and 72h) after randomization using a Mann-Whitney U test.Results: Among 464 participants, 91 (19.6%) developed AKI within 7 days of presentation (median onset 1.3 days), with similar rates between treatment arms (17% in 1:1:1 and to 22% in 1:1:2, p=0.13).Participants with AKI had higher ISS (32.93 vs. 26.4), received more blood products in total (31 vs.19 units), and had higher 30-day mortality (22% vs 9%).Doubling of sTM (adjusted RR = 1.96, 95% CI: 1.19 -3.24, p=0.008) and ang-2 (adjusted RR 1.35, 95% CI: 1.12 -1.62, p=0.002) on day 0 were associated with AKI.At 24 hours doubling of sTM (adjusted RR = 2.47, 95% CI: 1.90 -3.22, p <0.001) and ang-2 (adjusted RR 1.63, 95% CI: 1.42 -1.87, p<0.001) was significantly associated with AKI.In serially collected samples, concentrations of sTM and ang-2 at each timepoint were significantly higher in patients who developed AKI compared to patients who did not (Figure 1).Conclusions: Biomarkers of endovascular injury were significantly associated with AKI in patients with severe trauma.This analysis provides insight into the trajectories of these two biomarkers over the first 72 hours of critical illness and may help identify patients at increased risk for AKI early on in their presentation.
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4248183388