ReviewJournal of clinical laboratory analysis2026
The Landscape of Biomarkers in ICU-Associated AKI: From Protein Markers to Cell-Free Nucleic Acids.
Review in Journal of clinical laboratory analysis, 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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11 authors.
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Abstract
backgroundAcute kidney injury (AKI) affects approximately 30%-60% of intensive care unit (ICU) admissions, but early detection remains difficult because creatinine- and urine-output-based KDIGO criteria are delayed and confounded in critical illness.
objectiveTo summarize the biomarker landscape for ICU-associated AKI, focusing on kidney-targeted injury/stress proteins and circulating cell-free DNA (cfDNA), including mitochondrial DNA (mtDNA).
methodsPubMed/MEDLINE and Embase were searched from inception to December 31, 2025, using terms related to AKI, critical illness, NGAL, KIM-1, IL-18, L-FABP, [TIMP-2]·[IGFBP7], cfDNA, mtDNA, and damage-associated molecular patterns. Adult ICU studies reporting diagnostic performance, risk stratification, or clinically relevant outcomes were prioritized, especially in sepsis, cardiac surgery, shock, and trauma.
resultsNGAL, KIM-1, IL-18, L-FABP, and [TIMP-2]·[IGFBP7] often rise before creatinine or urine-output changes, providing early kidney-proximal signals of tubular injury or stress. cfDNA/mtDNA instead reflects systemic cell death, mitochondrial damage, and innate immune activation, capturing multi-organ injury and adding prognostic information beyond clinical scores and creatinine. Across ICU phenotypes, combining clinical risk, an early kidney-targeted marker, and cfDNA/mtDNA may improve identification of patients at risk for severe AKI, renal replacement therapy, and death.
conclusionsMultimarker strategies may widen the diagnostic window and sharpen prognostication in ICU-associated AKI. Routine implementation will require standardized pre-analytical handling, assay harmonization, biomarker-guided pragmatic trials, and trajectory-based decision tools that demonstrate clinical benefit.
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