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Introduction: Acute kidney injury (AKI) can evolve quickly and clinical measures of function often fail to detect AKI at a time when interventions are likely to provide benefit. Identifying early markers of kidney damage has been difficult due to the complex nature of human AKI, in which multiple etiologies exist. The objective of this study was to identify and validate novel biomarkers of AKI.
Methods: We performed two multicenter observational studies in critically ill patients at risk for AKI - discovery and validation. The top two markers from discovery were validated in a second study (Sapphire) and compared to a number of previously described biomarkers. In the discovery phase, we enrolled 522 adults in three distinct cohorts including patients with sepsis, shock, major surgery, and trauma and examined over 300 markers. In the Sapphire validation study, we enrolled 744 adult subjects with critical illness and without evidence of AKI at enrollment; the final analysis cohort was a heterogeneous sample of 728 critically ill patients. The primary endpoint was moderate to severe AKI (KDIGO stage 2 to 3) within 12 hours of sample collection.
Results: Moderate to severe AKI occurred in 14% of Sapphire subjects. The two top biomarkers from discovery were validated. Urine insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2), both inducers of G1 cell cycle arrest, a key mechanism implicated in AKI, together demonstrated an AUC of 0.80 (0.76 and 0.79 alone). Urine [TIMP-2].[IGFBP7] was significantly superior to all previously described markers of AKI (P <0.002), none of which achieved an AUC >0.72. Furthermore, [TIMP-2].[IGFBP7] significantly improved risk stratification when added to a nine-variable clinical model when analyzed using Cox proportional hazards model, generalized estimating equation, integrated discrimination improvement or net reclassification improvement. Finally, in sensitivity analyses [TIMP-2].[IGFBP7] remained significant and superior to all other markers regardless of changes in reference creatinine method.
Conclusions: Two novel markers for AKI have been identified and validated in independent multicenter cohorts. Both markers are superior to existing markers, provide additional information over clinical variables and add mechanistic insight into AKI. Trial registration: ClinicalTrials.gov number NCT01209169.
The azimuthal (Δφ) correlation distributions between heavy-flavor decay electrons and associated charged particles are measured in pp and p−Pb collisions at sNN−−−√=5.02 TeV. Results are reported for electrons with transverse momentum 4<pT<16 GeV/c and pseudorapidity |η|<0.6. The associated charged particles are selected with transverse momentum 1<pT<7 GeV/c, and relative pseudorapidity separation with the leading electron |Δη|<1. The correlation measurements are performed to study and characterize the fragmentation and hadronization of heavy quarks. The correlation structures are fitted with a constant and two von Mises functions to obtain the baseline and the near- and away-side peaks, respectively. The results from p−Pb collisions are compared with those from pp collisions to study the effects of cold nuclear matter. In the measured trigger electron and associated particle kinematic regions, the two collision systems give consistent results. The Δφ distribution and the peak observables in pp and p−Pb collisions are compared with calculations from various Monte Carlo event generators.
Inclusive photon production at forward rapidities in pp and p–Pb
collisions at √sNN = 5.02 TeV
(2023)
A study of multiplicity and pseudorapidity distributions of inclusive photons measured in pp and p−Pb collisions at a center-of-mass energy per nucleon−nucleon collision of sNN−−−√=5.02 TeV using the ALICE detector in the forward pseudorapidity region 2.3<ηlab<3.9 is presented. Measurements in p−Pb collisions are reported for two beam configurations in which the directions of the proton and lead ion beam were reversed. The pseudorapidity distributions in p−Pb collisions are obtained for seven centrality classes which are defined based on different event activity estimators, i.e., the charged-particle multiplicity measured at midrapidity as well as the energy deposited in a calorimeter at beam rapidity. The inclusive photon multiplicity distributions for both pp and p−Pb collisions are described by double negative binomial distributions. The pseudorapidity distributions of inclusive photons are compared to those of charged particles at midrapidity in \pp collisions and for different centrality classes in p−Pb collisions. The results are compared to predictions from various Monte Carlo event generators. None of the generators considered in this paper reproduces the inclusive photon multiplicity distributions in the reported multiplicity range. The pseudorapidity distributions are, however, better described by the same generators.
Inclusive photon production at forward rapidities in pp and p–Pb collisions at √sNN = 5.02 TeV
(2023)
A study of multiplicity and pseudorapidity distributions of inclusive photons measured in pp and p−Pb collisions at a center-of-mass energy per nucleon−nucleon collision of sNN−−−√=5.02 TeV using the ALICE detector in the forward pseudorapidity region 2.3<ηlab<3.9 is presented. Measurements in p−Pb collisions are reported for two beam configurations in which the directions of the proton and lead ion beam were reversed. The pseudorapidity distributions in p−Pb collisions are obtained for seven centrality classes which are defined based on different event activity estimators, i.e., the charged-particle multiplicity measured at midrapidity as well as the energy deposited in a calorimeter at beam rapidity. The inclusive photon multiplicity distributions for both pp and p−Pb collisions are described by double negative binomial distributions. The pseudorapidity distributions of inclusive photons are compared to those of charged particles at midrapidity in \pp collisions and for different centrality classes in p−Pb collisions. The results are compared to predictions from various Monte Carlo event generators. None of the generators considered in this paper reproduces the inclusive photon multiplicity distributions in the reported multiplicity range. The pseudorapidity distributions are, however, better described by the same generators.