Abstract

Background: AKI is a common problem in ICU patients and is mostly multifactorial. Also, it is known to increase mortality, duration of ICU and hospital stay and increase the cost of care in critically ill patients. Early diagnosis in these settings helps in decreasing the outcome of AKI. Multiple biomarkers have developed concentrating on early diagnosis of acute kidney injury. Urinary Chitinase 3 like protein 1 is a novel biomarker studied for early detection of acute kidney injury. Objectives: the current study was aimed to assess the role of urinary chitinase 3 like protein 1 (CHI3L1) as an early biomarker for detection of acute kidney injury in adult critically ill patients. Patients and methods: this was a prospective cohort study that was conducted in Ain Shams University Hospital. This study included 30 adult critically ill patients with normal kidney function and they were observed for 48 hours. The development of Acute Kidney Injury was based on serum creatinine and urine output criteria according to KDIGO criteria. Urine samples, for assessment of urinary CHI3L1, urine creatinine and urine CHI3L1/Cr ratio were collected under aseptic techniques at 3 times intervals ( 0, 12 and 24hrs). Results: our results showed that, of these 30 patients, 15 patients developed acute kidney injury using KDIGO criteria and 15 patients had normal kidney function. Our results showed the percentage of patient who developed AKI according to KDIGO, stage Ι 60.0%, stage ΙΙ 33.3% and stage ΙΙΙ 6.7%. Of these patients 80% developed AKI based on serum creatinine and 20% based on serum creatinine and urine output. Our results showed that there is statistically significant difference between AKI group and non-AKI group as regards urine chitinase 3 like protein 1(CHI3L1) at 0hour, 12 hours and 24hours (P≤0.05). As the higher level of urine CHI3L1 was found in AKI group which ranges from 35-135ng/ml with mean 94±34.02 at 0 hour, from 70-200ng/ml with mean 126.80±43.77 at 12 hours and from 105-200ng/ml with mean 160.57±28.02 which means that urine CHI3L1 level increases with AKI. Our results showed that there is statistically significant difference as regards urine CHI3L1 between non-AKI group and the 3 stages of AKI in AKI group at 0hr, 12hrs and 24hrs (P≤0.05). Conclusion: Urinary chitinase 3 like protein 1 is a highly sensitive early marker in prediction of acute kidney injury in adult critically ill patients.

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