Elevated neutrophil extracellular traps predict mortality and CKD progression in critically ill AKI patients: a prospective observational study.

BACKGROUND

Inflammation plays a pivotal role in the pathophysiology of acute kidney injury (AKI), mediating tubular damage, systemic complications, and modulation of kidney repair. Neutrophil extracellular traps (NETs) have emerged as key mediators of inflammation and tissue injury, though their role in AKI is not yet fully defined.

AIMS: This study aimed to evaluate NET levels in critically ill AKI patients and assess their association with disease severity, clinical outcomes, and progression to chronic kidney disease (CKD).

METHODS

In this prospective observational study, 73 critically ill AKI patients and 33 age- and sex-matched healthy controls were enrolled. NET levels were measured via ELISA at admission and post-recovery. Correlations with AKI severity (KDIGO stages), inflammatory markers (CRP, WBC), and clinical outcomes (mortality, ICU stay, CKD progression) were analyzed.

RESULTS

NET levels were significantly higher in AKI patients compared to controls (median: 364 vs. 264 pg/mL, p < 0.001) and correlated with AKI severity, APACHE II scores, and mortality. Elevated NETs predicted CKD progression (AUC = 0.919) and mortality (AUC = 0.855). Non-survivors had 82% higher median NETs at admission (571 vs. 313.5 pg/mL, p < 0.001), and persistent NET elevation post-recovery suggested ongoing subclinical inflammation.

CONCLUSIONS

NETs are elevated in AKI and independently predict CKD progression, infection risk, and mortality, supporting their use as dynamic prognostic biomarkers and potential therapeutic targets..