ArticleIndian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine2026
Renal Biomarkers of Injury as Early Predictors of COVID-19 Associated Acute Kidney Injury: A Prospective Observational Trial (BRICOAKI Study).
Article in Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims: Acute kidney injury (AKI) is a common and serious complication among critically ill COVID-19 patients. Early identification of patients at risk is challenging because serum creatinine rises late in the course of renal injury. Unlike prior COVID-19 AKI studies that measured serum neutrophil gelatinase-associated lipocalin (sNGAL) or Cystatin-C at a single time point, this study evaluates their serial trajectories and quantifies biomarker-creatinine lead-time in a critically ill intensive care unit (ICU) cohort. Patients and methods: This prospective observational study involved 65 adults with moderate to severe COVID-19 in the ICU. Serum biomarkers [NGAL, cystatin-C, interleukin (IL)-6, kidney injury molecule (KIM)-1, tissue inhibitor of metalloproteinases (TIMP)-2, creatinine] and urinary Klotho (uKlotho) were measured on days 0, 1, 2, 3, 5, 7, and 10. Acute kidney injury was defined per kidney disease: Improving global outcomes (KDIGO) criteria. Receiver operating characteristic (ROC) analysis and lead-time estimation evaluated predictive performance. Results: Acute kidney injury occurred in 47/65 (72.3%) patients; of them, 36/47 (76.6%) progressed to KDIGO stages 2-3, and 5 (10.6%) required renal replacement therapy (RRT). Among the biomarkers studied, sNGAL demonstrated the highest discrimination for KDIGO-defined AKI [area under curve (AUC): 0.71-0.79] and increased approximately 1 day before creatinine-based AKI diagnosis. Serum cystatin-C (sCystatin-C) showed moderate predictive value (AUC: 0.63-0.70) with a median lead time of approximately 1-2 days. Serum KIM-1 (sKIM-1) demonstrated only borderline variation across severity groups, while uKlotho did not show significant discriminatory performance. Although TIMP-2 and IL-6 were significantly elevated with increasing disease severity, their overall discriminative performance for AKI was lower compared with NGAL and cystatin-C. Conclusion: In critically ill COVID-19 patients, serial sNGAL and sCystatin-C demonstrated modest but consistent discrimination for KDIGO-defined AKI and showed a tendency to rise 1-2 days prior to creatinine-based diagnosis. In contrast, sKIM-1, serum TIMP-2, uKlotho, and serum IL-6 exhibited limited discriminatory performance for early AKI detection. How to cite this article: Kumar N, Mahto M, Kumar A, Kumar A, Kumar A. Renal Biomarkers of Injury as Early Predictors of COVID-19 Associated Acute Kidney Injury: A Prospective Observational Trial (BRICOAKI Study). Indian J Crit Care Med 2026;30(4):298-304.
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