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Plasma endostatin at intensive care admission is independently associated with acute kidney injury, dialysis, and mortality in COVID-19

Koozi, Hazem LU ; Engström, Jonas LU orcid ; Zwawi, Ahmad ; Spångfors, Martin LU orcid ; Didriksson, Ingrid LU orcid ; Larsson, Anders ; Friberg, Hans LU and Frigyesi, Attila LU (2025) In Intensive Care Medicine Experimental 13. p.1-11
Abstract
Background
Critical COVID-19 is associated with high mortality, and acute kidney injury (AKI) is common. Endostatin has emerged as a promising prognostic biomarker for predicting AKI and mortality in intensive care. This study aimed to investigate plasma endostatin at intensive care unit (ICU) admission as a biomarker for AKI, renal replacement therapy (RRT), and 90-day mortality in COVID-19.

Methods
A pre-planned retrospective analysis of a prospectively collected cohort of admissions with a primary SARS-CoV-2 infection to six ICUs in southern Sweden between May 2020 and May 2021 was undertaken. Endostatin at ICU admission was evaluated with multivariable logistic regression analyses adjusted for age, sex, C-reactive... (More)
Background
Critical COVID-19 is associated with high mortality, and acute kidney injury (AKI) is common. Endostatin has emerged as a promising prognostic biomarker for predicting AKI and mortality in intensive care. This study aimed to investigate plasma endostatin at intensive care unit (ICU) admission as a biomarker for AKI, renal replacement therapy (RRT), and 90-day mortality in COVID-19.

Methods
A pre-planned retrospective analysis of a prospectively collected cohort of admissions with a primary SARS-CoV-2 infection to six ICUs in southern Sweden between May 2020 and May 2021 was undertaken. Endostatin at ICU admission was evaluated with multivariable logistic regression analyses adjusted for age, sex, C-reactive protein, and creatinine. Net reclassification index analyses were also performed.

Results
Four hundred eighty-four patients were included. Endostatin showed a non-linear association with AKI, RRT, and 90-day mortality. Endostatin levels of 100–200 ng/mL were associated with AKI on ICU day 1 (OR 5.1, 95% CI 1.5–18, p = 0.0097), RRT during the ICU stay (OR 3.5, 95% CI 1.1–12, p = 0.039), and 90-day mortality (OR 4.2, 95% CI 1.6–11, p = 0.0037). Adding endostatin to creatinine improved prediction of AKI on ICU day 1, while adding it to a model containing age, sex, CRP, and creatinine improved prediction of both AKI on ICU day 1 and 90-day mortality, but not RRT.

Conclusions
Endostatin at ICU admission was independently associated with AKI, RRT, and 90-day mortality in ICU patients with COVID-19. In addition, endostatin improved the prediction of AKI and 90-day mortality, highlighting its potential as a biomarker for early risk stratification in intensive care. (Less)
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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Intensive Care Medicine Experimental
volume
13
article number
42
pages
1 - 11
publisher
Springer Nature
external identifiers
  • scopus:105002877691
  • pmid:40178654
ISSN
2197-425X
DOI
10.1186/s40635-025-00748-6
language
English
LU publication?
yes
id
d45f5327-2efe-44ca-894d-393b6755343b
date added to LUP
2025-04-04 21:00:31
date last changed
2025-07-05 03:00:09
@article{d45f5327-2efe-44ca-894d-393b6755343b,
  abstract     = {{Background<br/>Critical COVID-19 is associated with high mortality, and acute kidney injury (AKI) is common. Endostatin has emerged as a promising prognostic biomarker for predicting AKI and mortality in intensive care. This study aimed to investigate plasma endostatin at intensive care unit (ICU) admission as a biomarker for AKI, renal replacement therapy (RRT), and 90-day mortality in COVID-19.<br/><br/>Methods<br/>A pre-planned retrospective analysis of a prospectively collected cohort of admissions with a primary SARS-CoV-2 infection to six ICUs in southern Sweden between May 2020 and May 2021 was undertaken. Endostatin at ICU admission was evaluated with multivariable logistic regression analyses adjusted for age, sex, C-reactive protein, and creatinine. Net reclassification index analyses were also performed.<br/><br/>Results<br/>Four hundred eighty-four patients were included. Endostatin showed a non-linear association with AKI, RRT, and 90-day mortality. Endostatin levels of 100–200 ng/mL were associated with AKI on ICU day 1 (OR 5.1, 95% CI 1.5–18, p = 0.0097), RRT during the ICU stay (OR 3.5, 95% CI 1.1–12, p = 0.039), and 90-day mortality (OR 4.2, 95% CI 1.6–11, p = 0.0037). Adding endostatin to creatinine improved prediction of AKI on ICU day 1, while adding it to a model containing age, sex, CRP, and creatinine improved prediction of both AKI on ICU day 1 and 90-day mortality, but not RRT.<br/><br/>Conclusions<br/>Endostatin at ICU admission was independently associated with AKI, RRT, and 90-day mortality in ICU patients with COVID-19. In addition, endostatin improved the prediction of AKI and 90-day mortality, highlighting its potential as a biomarker for early risk stratification in intensive care.}},
  author       = {{Koozi, Hazem and Engström, Jonas and Zwawi, Ahmad and Spångfors, Martin and Didriksson, Ingrid and Larsson, Anders and Friberg, Hans and Frigyesi, Attila}},
  issn         = {{2197-425X}},
  language     = {{eng}},
  month        = {{04}},
  pages        = {{1--11}},
  publisher    = {{Springer Nature}},
  series       = {{Intensive Care Medicine Experimental}},
  title        = {{Plasma endostatin at intensive care admission is independently associated with acute kidney injury, dialysis, and mortality in COVID-19}},
  url          = {{http://dx.doi.org/10.1186/s40635-025-00748-6}},
  doi          = {{10.1186/s40635-025-00748-6}},
  volume       = {{13}},
  year         = {{2025}},
}