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Using data from a sub-cohort (440 patients) of the prospective multicentre LifePOC study (1434 patients), proenkephalin A 119\u2212159 (penKid) was assessed for early identification of subclinical kidney damage compared to serum creatinine in emergency patients with a qSOFA score \u22651. Logistic regression was applied to assess the usefulness of penKid, four further biomarkers (midregional pro-adrenomedullin, bioactive adrenomedullin, dipeptidyl-peptidase-3, procalcitonin) and clinical risk factors to predict AKI within 24 h, 48 h and 72 h after admission, need for organ support and 28-day mortality. PenKid and bio-adrenomedullin performed moderately to predict AKI within 48 h (AUC 0.645, 95% CI: 0.582\u20130.703 and AUC 0.647, 95% CI: 0.583\u20130.707, respectively). Pre-existing chronic kidney disease (OR 2.36, 95% CI: 1.06\u20135.27), confirmed sepsis (OR 2.41, 95% CI: 1.28\u20134.56), mechanical ventilation (OR 3.03, 95% CI: 1.48\u20136.19), and elevated levels of penKid (OR 2.21, 95% CI: 1.60\u20133.07) at admission were associated with an increased risk of AKI whereas a restrictive fluid management (OR 0.43, 95% CI: 0.26\u20130.71) was associated with a lower risk of AKI. Patients at high AKI risk may be identified based on specific risk factors, bio-ADM and penKid. The trial was registered in the German Registry for Clinical Trials (DRKS00011188) on 20 October 2016.<\/jats:p>","DOI":"10.1371\/journal.pone.0339763","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:30:24Z","timestamp":1771439424000},"page":"e0339763","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["NephroPOC - Risk assessment and prediction of acute kidney injury in emergency patients with suspected organ dysfunction: Secondary analysis from the prospective observational LifePOC 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