Predicting Renal Replacement Therapy Requirement In Sepsis-Associated Acute Kidney Injury Using Furosemide Stress...

Area of Science:

• Nephrology
• Critical Care Medicine
• Biomarker Research

Background:

• Sepsis-associated acute kidney injury (SA-AKI) is a common and severe complication in intensive care units (ICUs).
• Early identification of SA-AKI patients requiring renal replacement therapy (RRT) is crucial for timely intervention and improved outcomes.
• Current predictive models for RRT in SA-AKI have limitations in accuracy and timeliness.

Purpose of the Study:

• To evaluate the predictive value of a combined model using the furosemide stress test (FST) and urinary biomarkers (tissue inhibitor of metalloproteinase-2 [TIMP-2] and insulin-like growth factor-binding protein 7 [IGFBP-7]) for RRT initiation within 7 days in SA-AKI patients.
• To assess the performance of this combined model compared to individual components.

Main Methods:

• A prospective study involving 63 SA-AKI patients admitted to ICUs.
• Patients were divided into RRT (n=20) and non-RRT (n=43) groups based on RRT initiation within 7 days.
• Urinary TIMP-2 and IGFBP-7 levels were measured using ELISA. The furosemide stress test (FST) was performed, and urinary biomarkers were re-measured 2 hours post-FST.
• Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were used to evaluate predictive performance.

Main Results:

• The combined model incorporating FST and urinary [TIMP-2] * [IGFBP-7] demonstrated a high area under the curve (AUC) of 0.966.
• Individual components also showed predictive value: FST (AUC=0.878), baseline TIMP-2*IGFBP-7 (AUC=0.820), and post-FST TIMP-2*IGFBP-7 (AUC=0.845).
• The combined model was identified as an independent predictor of RRT requirement in SA-AKI patients.

Conclusions:

• The combined model of FST and urinary TIMP-2*IGFBP-7 offers a robust and accurate tool for early risk stratification of SA-AKI patients.
• This model can help identify patients at high risk of requiring RRT, enabling prompt clinical decision-making.
• Further validation in larger cohorts is warranted to confirm its clinical utility.