Urine Complement Factor Ba Identifies Persistent AKI and Organ Failures in Critically Ill Adults.
Kidney International Reports（2024）
Abstract
Background Critically ill adults with acute kidney injury (AKI) have high morbidity and mortality and lack treatment options. We assessed the association between complement activation (urine Ba fragment levels), and AKI and organ failures. Methods A biorepository of critically ill adults was leveraged. AKI staging was based on KDIGO creatinine (sCr) criteria. AKI recovery was defined as sCr reduction to <0.3mg/dl above baseline within 48 hours after AKI diagnosis. Persistent AKI was defined as need for renal replacement or no sCr recovery. Urine was obtained at ICU admission, 12, and 24 hours after admission, and urine Ba levels were quantitated via ELISA and natural log transformed. Regression analyses were performed to test the association between urine Ba and organ failure outcomes. We adjusted for age and APACHE-II score. Results 439 patients were included: 252 without AKI, 124 stage 1 AKI, 43 stage 2 AKI, and 20 stage 3 AKI. After adjusting for covariates, urine Ba increased as AKI stage increased. Urine Ba was higher in patients with persistent AKI compared to patients with AKI recovery and without AKI. Increased urine Ba was associated with worse organ failure outcomes (fewer ventilator, ICU, and inotrope free days, and fewer days alive). Conclusions Urine Ba is increased in patients with severe AKI and discriminates between patients who have AKI recovery from patients who develop persistent AKI. A doubling of urine Ba was associated with a 6.6 fold increased odds of persistent AKI. Future studies to validate these findings and to trial complement factor B inhibition are warranted.
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Key words
complement system proteins,acute kidney injury,critical illness
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