This research aims to investigate the role of daily measurement of urinary cell cyclearrest markers and other serum and urinary biomarkers to predict the development of acutekidney injury in critically ill patients with COVID-19 and acute respiratory disease.
COVID-19 is a rapidly evolving pandemic with approximately 5% of all patients requiring
admission to an intensive care unit. In critically ill patients with COVID-19, acute
respiratory disease and acute kidney injury (AKI) are very common. Patients with AKI have
an increased risk of mortality, especially renal replacement therapy (RRT) is required.
The latest Intensive Care National Audit & Research Centre (ICNARC) report shows a 77%
ICU mortality in patients with COVID-19 who require mechanical ventilation and RRT.
COVID-19 associated AKI is still poorly understood. The exact underlying pathophysiology
remains unknown. Furthermore, there are no specific strategies to prevent or treat AKI.
Management is supportive consisting of fluid and haemodynamic optimization,
discontinuation of nephrotoxic drugs and prevention of nephrotoxic exposures. Ideally,
AKI needs to be recognized as early as possible for these supportive measures to be
effective.
Early prediction of AKI may be valuable to optimize management and improve outcomes. In
critically ill patients without COVID-19, the two cell-cycle arrest markers, tissue
inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth-factor binding protein
7 (IGFBP7), have been shown to predict the development of AKI. Whether these new
biomarkers also predict the development of AKI in critically ill patients with COVID-19
is unknown.
The aim of this project is to explore whether urinary cell cycle arrest markers and other
renal biomarkers have a role in predicting AKI in critically ill patients with COVID-19
and acute respiratory disease. The results will advance the understanding of this disease
and serve to develop strategies for individualized management of this high-risk group.
Inclusion Criteria:
1. Moderate or severe respiratory disease as defined by Berlin criteria
2. COVID-19 positive
3. Age ≥ 18 years
Exclusion Criteria:
1. pre-existing AKI
2. severe chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR)
<20ml/min
3. end-stage renal failure on regular dialysis
4. kidney transplant within the last 12 months
5. pregnancy
6. breastfeeding
Guy's & St Thomas' Hospital
London, United Kingdom
Investigator: Marlies Ostermann, MD, PhD
Contact: 020 71883038
Marlies.Ostermann@gstt.nhs.uk
Marlies Ostermann, MD, PhD
0044 207 188 3038 - 83036
Marlies.Ostermann@gstt.nhs.uk
Nuttha Lumlertgul, MD, PhD
0044 207 188 3038 - 83036
Nuttha.Lumlertgul@gstt.nhs.uk
Marlies Ostermann, MD, PhD, Principal Investigator
Guy's and St Thomas' NHS Foundation Trust