{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:42:56Z","timestamp":1790667776156,"version":"4.1.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,9,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Subclinical acute kidney injury (sub-AKI) refers to patients with low serum creatinine but elevated alternative biomarkers of AKI. Its incidence and outcome in critically ill patients remain, however, largely unknown. Plasma proenkephalin A 119\u2013159 (penKid) has been proposed as a sensitive biomarker of glomerular function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In this ancillary study of two cohorts, we explored the incidence and outcome of sub-AKI based on penKid.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective observational study in ICUs was conducted. FROG-ICU (French and European Outcome Registry in ICUs) enrolled 2,087 critically ill patients, and AdrenOSS-1 (Adrenomedullin and Outcome in Severe Sepsis and Septic Shock-1) enrolled 583 septic patients. The primary endpoint was 28-day mortality after ICU admission. Sub-AKI was defined by an admission penKid concentration above the normal range (i.e., &amp;gt;80 pmol\/L) in patients not meeting the definition of AKI. A sensitivity analysis was performed among patients with estimated glomerular filtration rate above 60 ml\/min\/1.73 m2 at ICU admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>In total, 6.1% (122\/2,004) and 6.7% (39\/583) of patients from the FROG-ICU and AdrenOSS-1 cohorts met the definition of sub-AKI (11.6% and 17.5% of patients without AKI). In patients without AKI or with high estimated glomerular filtration rate, penKid was associated with higher mortality (adjusted standardized hazard ratio [HR], 1.4 [95% confidence interval, 1.1\u20131.8]; P\u2009=\u20090.010; and HR, 1.6 [95% confidence interval, 1.3\u20131.8]; P\u2009&amp;lt;\u20090.0001, respectively) after adjustment for age, sex, comorbidities, diagnosis, creatinine, diuresis, and study. Patients with sub-AKI had higher mortality compared with no AKI (HR, 2.4 [95% confidence interval, 1.5\u20133.7] in FROG-ICU and 2.5 [95% confidence interval, 1.1\u20135.9] in AdrenOSS-1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sub-AKI defined using penKid occurred in 11.6\u201317.5% of patients without AKI and was associated with a risk of death close to patients with AKI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201910-1950oc","type":"journal-article","created":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T18:53:32Z","timestamp":1591728812000},"page":"822-829","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":66,"title":["Incidence and Outcome of Subclinical Acute Kidney Injury Using penKid in Critically Ill Patients"],"prefix":"10.1093","volume":"202","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9988-4317","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"D\u00e9pret","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis\u2013Lariboisi\u00e8re University Hospitals, Assistance Publique\u2013H\u00f4pitaux de Paris (AP-HP), Paris, France"},{"name":"UMR-S942, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Lariboisi\u00e8re Hospital, Paris, France"},{"name":"INI-CRCT Network, Paris, France"},{"name":"Paris University, Paris, France"},{"name":"INSERM 942, FHU Promice, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6799-1652","authenticated-orcid":false,"given":"Alexa","family":"Hollinger","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis\u2013Lariboisi\u00e8re University Hospitals, Assistance Publique\u2013H\u00f4pitaux de Paris (AP-HP), Paris, France"},{"name":"UMR-S942, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Lariboisi\u00e8re Hospital, Paris, France"},{"name":"Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Cariou","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Deye","sequence":"additional","affiliation":[{"name":"UMR-S942, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Lariboisi\u00e8re Hospital, Paris, France"},{"name":"Medical Intensive Care Unit, Saint Louis\u2013Lariboisi\u00e8re University Hospitals, AP-HP, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Vieillard-Baron","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, University Hospital Ambroise Par\u00e9, AP-HP, Boulogne-Billancourt, France"},{"name":"INSERM U-1018, CESP, Team 5, University of Versailles, Saint-Quentin en Yvelines, France"},{"name":"Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles, Saint-Quentin en Yvelines, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-C\u00e9line","family":"Fournier","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis\u2013Lariboisi\u00e8re University Hospitals, Assistance Publique\u2013H\u00f4pitaux de Paris (AP-HP), Paris, France"},{"name":"UMR-S942, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Lariboisi\u00e8re Hospital, Paris, France"},{"name":"INSERM 942, 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