Longitudinal urinary 8-oxoGuo improves prognostication beyond SOFA scores in critically ill patients
Investigators evaluated serial urinary 8-oxo-7,8-dihydroguanosine (8-oxoGuo) levels in 438 critically ill adults across 2,516 samples to assess prognostic value during ICU and post-ICU care. Using isotope-dilution UPLC-MS/MS, they found that each doubling of longitudinal 8-oxoGuo was associated with higher 90-day mortality (HR 1.47) and increased post-ICU mortality (HR 1.52), while showing no consistent link for the related DNA oxidation marker 8-oxodGuo. Incorporating 8-oxoGuo trajectories into baseline SOFA scores improved discrimination for 90-day mortality (AUC 0.669 to 0.719) and post-ICU mortality (AUC 0.682 to 0.741). The study reports that serial urinary 8-oxoGuo provides incremental prognostic information beyond standard severity scores, highlighting its potential utility for risk stratification in critical care diagnostics.
The original study
Longitudinal Urinary 8-oxoGuo as a Potential Biomarker of Persistent Risk During ICU and Post-ICU Hospitalization.
- Authors
- Chen CJ, Xu RA, Hong GL, Liu HL, Quan JH, Chen X, et al.
- Journal
- Free radical research
- Type
- Journal Article
- PMID
- 42799355
Original abstract
Persistent biological injury may remain undetected despite apparent clinical stabilization during critical illness. We evaluated whether serial urinary markers of RNA and DNA oxidation were associated with 90-day mortality, transition from ICU to post-ICU phase, and mortality after ICU discharge, and whether they provided prognostic information beyond baseline illness severity. This single-center longitudinal cohort included 438 critically ill adults who provided 2,516 urine samples during ICU and post-ICU hospitalization. Urinary 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo) were quantified by isotope-dilution ultra-performance liquid chromatography-tandem mass spectrometry and normalized to creatinine. Bayesian joint models were adjusted for age, sex, Charlson Comorbidity Index, and baseline Sequential Organ Failure Assessment (SOFA) score. Each doubling of longitudinal urinary 8-oxoGuo was associated with higher 90-day mortality (hazard ratio [HR], 1.47; 95% credible interval [CrI], 1.17-1.85), higher mortality after ICU discharge (HR, 1.52; 95% CrI, 1.18-1.97), and a lower transition rate to post-ICU care (HR, 0.89; 95% CrI, 0.79-0.99). Associations were similar when APACHE II replaced SOFA, whereas longitudinal 8-oxodGuo showed no consistent associations. Adding baseline 8-oxoGuo to SOFA increased the area under the curve for 90-day mortality from 0.669 to 0.719 (P = 0.046), while incorporating longitudinal trajectory information increased it for mortality after ICU discharge from 0.682 to 0.741 (P = 0.029). Overall, these findings indicate that higher longitudinal urinary 8-oxoGuo is associated with adverse outcomes across ICU and post-ICU hospitalization and provides incremental prognostic discrimination beyond baseline SOFA.