Predictive performance of kinetic eGFR, midregional proadrenomedullin, and H3.1 nucleosomes for acute kidney disease in sepsis: a secondary analysis of a large multicentre randomized controlled trial
Primary result · AKDResult — go to the resultAdjusted odds ratio 1.17 95% CI 1.08–1.28Authors' conclusion
In patients with sepsis, MR-proADM at baseline and dynamic changes in kinetic eGFR during the first week were independently associated with AKD, whereas histone H3.1 nucleosomes provided limited predictive value. Although multimarker models seemed to modestly improve baseline discrimination, this advantage was not sustained over time and added little clinical benefit beyond kinetic eGFR.
Study context
- Population
- Patients with sepsis, excluding pre-existing RRT or missing AKI data
- Participants
- 690 patients
- Comparison
- Kinetic eGFR, midregional pro-adrenomedullin (MR-proADM) and H3.1 nucleosomes, alone and combined, for prediction of acute kidney disease (AKD)
- Primary endpoint
- Acute kidney disease (AKD)
Methodological detailsmulticentre, prognostic biomarker study
- Multicentre
- Prognostic biomarker study
Primary result
AKD
Adjusted odds ratio
1.17
95% CI 1.08–1.28
P < 0.001
By group
MR-proADM
1.17
aOR at baseline
Combined model
- AUC baseline
- 0.65
- AUC day 2
- 0.70
- AUC day 7
- 0.76
MR-proADM vs kinetic eGFR
aOR 1.17 (95% CI 1.08–1.28); P < 0.001
As reported in the abstract
- AKD incidence
- 196 patients (28.4%)
- At day 2 and day 7 only changes in kinetic eGFR independently associated with AKD
- both p < 0.001
Further findings
| Outcome | AKD | No AKD | RR (95% CI) | |
|---|---|---|---|---|
| 90-day mortality by AKD | 55% | 24% | 2.3 (1.9–2.9) | |
| 0.20.5125Relative risk (log scale) |
Renal recovery
- Biomarkers showed limited and inconsistent performance for prediction of renal recovery
Original publication
Predictive performance of kinetic eGFR, midregional proadrenomedullin, and H3.1 nucleosomes for acute kidney disease in sepsis: a secondary analysis of a large multicentre randomized controlled trial. J Intensive Care. Published 19 August 2026. doi:10.
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