Comparison of C-C motif chemokine ligand 14 to other biomarkers for adverse kidney events after cardiac surgery

Abstract Objective Outcomes after acute kidney injury (AKI) are affected by both the severity and duration of the insult. Patients with persistent AKI have much higher major adverse kidney events (MAKE) including 90-day mortality, renal replacement therapy (RRT) and persistent kidney dysfunction. Methods to identify these patients are urgently needed in order to improve outcomes. The purpose of this study was to evaluate whether biomarkers, including C-C motif chemokine ligand 14 (CCL14), were able to predict persistent AKI and MAKE following cardiac surgery. Methods This study was a single-center, prospective, observational study. Patients who developed moderate or severe AKI (KDIGO2 or 3) within 72h after cardiac surgery were enrolled with a primary endpoint of persistent severe AKI (KDIGO3) lasting for ≥ 72h. Results 100 patients were available for the primary analysis, 37 met the primary endpoint. CCL14 was the most predictive biomarker for the primary endpoint with an area under the curve (AUC) of 0.930 (95%CI, 0.881-0.979). The AUC of CCL14 was significantly higher than the AUCs for the other biomarkers analyzed. CCL14 was significantly higher in endpoint-positive patients at enrollment (4.47ng/ml (2.35-11.5) vs. 0.67ng/ml (0.38-1.07); P=0.001). Sensitivity and specificity were 78% and 95% at a cutoff value of 2.21ng/ml, respectively. CCL14 was also highly accurate for predicting RRT within 7d (AUC0.915, 95%CI 0.858-0.972; P Conclusions Elevated CCL14 levels predict persistent AKI in cardiac surgery patients with moderate or severe AKI. This new biomarker may help stratify patients destined to receive RRT and identify patients who may benefit from novel therapeutic approaches to AKI.