Predictive effect of urinary C-C motif chemokine ligand 14 (CCL14) in combination with human liver-type fatty acid-binding protein (L-FABP) in patients with combined persistent AKI in the ICU: A prospective study

Pengcheng Yan ¹ wenqiang li ² ye LI ¹ yazhen mei ¹ yingguang xie ^2*

• ¹ Jining Medical University, Jining, China
• ² Jining No.1 People's Hospital, Jining, China

Background: Acute kidney injury (AKI) is a common syndrome in intensive care units (ICUs). As AKI is a heterogeneous and comprehensive disease, patients with transient AKI (T-AKI) are at greater risk of adverse outcomes than are those with persistent AKI (P-AKI). Currently, many experiments involve the use of different biomarkers to differentiate between the two types of AKI. The present study focused on evaluating urinary C-C Motif Chemokine Ligand 14 (CCL14) versus urinary liver-type Fatty Acid Binding Protein (L-type Fatty Acid Binding Protein, L-FABP) in ICU patients with combined persistent AKI. Methods: We conducted a prospective study to analyze the predictive role of urinary CCL14 versus L-FABP for renal recovery from AKI. Patients who developed AKI after ICU admission were enrolled, and urinary biomarkers, including C-C Matrix Chemokine Ligand 14 (Urinary C-C Motif Chemokine Ligand 14, CCL14) and Liver-type Fatty Acid Binding Protein (L-FABP), were tested on the day of AKI diagnosis. The primary endpoint was failure to recover from AKI within 7 days. The individual discriminatory ability of CCL14 and L-FABP to predict renal nonrecovery was evaluated via the area under the working characteristic curve (AUC) of the subjects.Results: Forty-four of the 80 patients with AKI had persistent AKI.CCL14 was the best predictor of persistent AKI, with an AUC of 0.842 (95% CI: 0.757-0.924). L-FABP was an average predictor of renal nonrecovery, with an AUC of 0.707 (95% CI: 0.592-0.822).When CCL14 was combined with L-FABP, the AUC was 0.834 (95% CI: 0.747-0.921), and when CCL14 was combined with the clinical model, the AUC was significantly increased to 0.893 (0.821-0.965).Conclusions: Urinary CCL14 is highly effective at predicting persistent AKI in critically ill patients, whereas urinary L-FABP is moderately effective at differentiating transient AKI from persistent AKI.