Comprehensive Summary
This retrospective, multicenter study across 4 ICUs examined whether ICU admission plasma endostatin independently predicts new-onset acute kidney injury (AKI), renal replacement therapy (RRT), and 30-day mortality in critically ill patients. Plasma endostatin was measured in 4732 ICU admissions. AKI was defined according to KDIGO criteria. The predictive value of ICU admission plasma endostatin for AKI, RRT and 30-day mortality was compared with creatinine, cystatin C and the Simplified Acute Physiology Score 3 (SAPS-3). Endostatin independently predicted new-onset AKI (OR 1.7, 95% CI 1.5–1.9), stage 3 AKI (OR 1.4, 95% CI 1.2-1.6), and RRT (OR 1.2, 95% CI 1.05-1.4). Furthermore, endostatin alone outperformed creatinine and cystatin C for predicting new-onset AKI (mean AUC 0.67 vs. 0.63, p < 0.001). Endostatin with creatinine increased the predictive value of new-onset AKI and new-onset stage 3 AKI, but not RRT. Endostatin was not associated with 30-day mortality, even after adjustment for SAPS-3.
Outcomes and Implications
Early detection of new-onset AKI is critical for timely clinical decision-making in ICU patients. Creatinine is a suboptimal predictor of AKI, whereas plasma endostatin emerges as a promising biomarker to improve early AKI risk assessment. This study shows that ICU admission endostatin independently predicts new-onset AKI and stage 3 AKI, outperforming cystatin C and creatinine for new-onset AKI. However, the predictive gain is modest, and it is limited for RRT and 30-day mortality. As a retrospective study, incomplete data and a single geographic focus limit generalizability. Prospective studies are needed to validate endostatin’s predictive role in AKI and RRT, and to clarify its clinical utility in the ICU.