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Combined biomarker analysis for risk of acute kidney injury in patients with ST-segment elevation myocardial infarction.

Tung YC, Chang CH, Chen YC, Chu PH - PLoS ONE (2015)

Bottom Line: Serum levels of the biomarkers were correlated with risk of AKI and the Acute Kidney Injury Network (AKIN) stage and all significantly discriminated AKI (area under the receiver operating characteristic [ROC] curve: BNP: 0.86, sST2: 0.74, NGAL: 0.75, cystatin C: 0.73; all P < 0.05).Elevation of ≥2 of the biomarkers higher than the cutoff values derived from the ROC analysis improved AKI risk stratification, regardless of the creatine level (creatinine < 1.24 mg/dL: odds ratio [OR] 11.25, 95% confidence interval [CI] 1.63-77.92, P = 0.014; creatinine ≥ 1.24: OR 15.0, 95% CI 1.23-183.6, P = 0.034).High serum levels of the biomarkers were associated with an elevated risk and more advanced stage of AKI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan.

ABSTRACT

Background: Acute kidney injury (AKI) complicating ST-segment elevation myocardial infarction (STEMI) increases subsequent morbidity and mortality. We combined the biomarkers of heart failure (HF; B-type natriuretic peptide [BNP] and soluble ST2 [sST2]) and renal injury (NGAL [neutrophil gelatinase-associated lipocalin] and cystatin C) in predicting the development of AKI in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods and results: From March 2010 to September 2013, 189 STEMI patients were sequentially enrolled and serum samples were collected at presentation for BNP, sST2, NGAL and cystatin C analysis. 37 patients (19.6%) developed AKI of varying severity within 48 hours of presentation. Univariate analysis showed age, Killip class ≥2, hypertension, white blood cell counts, hemoglobin, estimated glomerular filtration rate, blood urea nitrogen, creatinine, and all the four biomarkers were predictive of AKI. Serum levels of the biomarkers were correlated with risk of AKI and the Acute Kidney Injury Network (AKIN) stage and all significantly discriminated AKI (area under the receiver operating characteristic [ROC] curve: BNP: 0.86, sST2: 0.74, NGAL: 0.75, cystatin C: 0.73; all P < 0.05). Elevation of ≥2 of the biomarkers higher than the cutoff values derived from the ROC analysis improved AKI risk stratification, regardless of the creatine level (creatinine < 1.24 mg/dL: odds ratio [OR] 11.25, 95% confidence interval [CI] 1.63-77.92, P = 0.014; creatinine ≥ 1.24: OR 15.0, 95% CI 1.23-183.6, P = 0.034).

Conclusions: In this study of STEMI patients undergoing primary PCI, the biomarkers of heart failure (BNP and sST2) and renal injury (NGAL and cystatin C) at presentation were predictive of AKI. High serum levels of the biomarkers were associated with an elevated risk and more advanced stage of AKI. Regardless of the creatinine level, elevation of ≥2 of the biomarkers higher than the cutoff values indicated a further rise in AKI risk. Combined biomarker approach may assist in risk stratification of AKI in patients with STEMI.

No MeSH data available.


Related in: MedlinePlus

Serum levels of the biomarkers at presentation and the Acute Kidney Injury Network (AKIN) stages in patients developing acute kidney injury within 48 hours.Serum levels of BNP (A), sST2 (B), NGAL (C) and cystatin C (D) at presentation increased significantly across the spectrum of the AKIN stages within 48 hours.
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pone.0125282.g001: Serum levels of the biomarkers at presentation and the Acute Kidney Injury Network (AKIN) stages in patients developing acute kidney injury within 48 hours.Serum levels of BNP (A), sST2 (B), NGAL (C) and cystatin C (D) at presentation increased significantly across the spectrum of the AKIN stages within 48 hours.

Mentions: Fig 1 illustrates the association of serum levels of the biomarkers and the AKIN stage. Serum levels of BNP, sST2, NGAL and cystatin C increased significantly across the spectrum of the AKIN stages. The risk of AKI also positively correlated with the serum levels of the biomarkers (Fig 2). Using the creatine cutoff value of 1.24 mg/dL to group the STEMI patients into low and high risk of AKI, a further rise in risk was noted in the both groups if the patients presented with ≥2 biomarkers elevated higher than the cutoff values derived from the ROC analysis (Fig 3). This result implied that elevation of the biomarkers at presentation help discriminate the development of AKI within 48 hours, even in patients considered to be of low risk based on the creatine levels.


Combined biomarker analysis for risk of acute kidney injury in patients with ST-segment elevation myocardial infarction.

Tung YC, Chang CH, Chen YC, Chu PH - PLoS ONE (2015)

Serum levels of the biomarkers at presentation and the Acute Kidney Injury Network (AKIN) stages in patients developing acute kidney injury within 48 hours.Serum levels of BNP (A), sST2 (B), NGAL (C) and cystatin C (D) at presentation increased significantly across the spectrum of the AKIN stages within 48 hours.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390355&req=5

pone.0125282.g001: Serum levels of the biomarkers at presentation and the Acute Kidney Injury Network (AKIN) stages in patients developing acute kidney injury within 48 hours.Serum levels of BNP (A), sST2 (B), NGAL (C) and cystatin C (D) at presentation increased significantly across the spectrum of the AKIN stages within 48 hours.
Mentions: Fig 1 illustrates the association of serum levels of the biomarkers and the AKIN stage. Serum levels of BNP, sST2, NGAL and cystatin C increased significantly across the spectrum of the AKIN stages. The risk of AKI also positively correlated with the serum levels of the biomarkers (Fig 2). Using the creatine cutoff value of 1.24 mg/dL to group the STEMI patients into low and high risk of AKI, a further rise in risk was noted in the both groups if the patients presented with ≥2 biomarkers elevated higher than the cutoff values derived from the ROC analysis (Fig 3). This result implied that elevation of the biomarkers at presentation help discriminate the development of AKI within 48 hours, even in patients considered to be of low risk based on the creatine levels.

Bottom Line: Serum levels of the biomarkers were correlated with risk of AKI and the Acute Kidney Injury Network (AKIN) stage and all significantly discriminated AKI (area under the receiver operating characteristic [ROC] curve: BNP: 0.86, sST2: 0.74, NGAL: 0.75, cystatin C: 0.73; all P < 0.05).Elevation of ≥2 of the biomarkers higher than the cutoff values derived from the ROC analysis improved AKI risk stratification, regardless of the creatine level (creatinine < 1.24 mg/dL: odds ratio [OR] 11.25, 95% confidence interval [CI] 1.63-77.92, P = 0.014; creatinine ≥ 1.24: OR 15.0, 95% CI 1.23-183.6, P = 0.034).High serum levels of the biomarkers were associated with an elevated risk and more advanced stage of AKI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan.

ABSTRACT

Background: Acute kidney injury (AKI) complicating ST-segment elevation myocardial infarction (STEMI) increases subsequent morbidity and mortality. We combined the biomarkers of heart failure (HF; B-type natriuretic peptide [BNP] and soluble ST2 [sST2]) and renal injury (NGAL [neutrophil gelatinase-associated lipocalin] and cystatin C) in predicting the development of AKI in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods and results: From March 2010 to September 2013, 189 STEMI patients were sequentially enrolled and serum samples were collected at presentation for BNP, sST2, NGAL and cystatin C analysis. 37 patients (19.6%) developed AKI of varying severity within 48 hours of presentation. Univariate analysis showed age, Killip class ≥2, hypertension, white blood cell counts, hemoglobin, estimated glomerular filtration rate, blood urea nitrogen, creatinine, and all the four biomarkers were predictive of AKI. Serum levels of the biomarkers were correlated with risk of AKI and the Acute Kidney Injury Network (AKIN) stage and all significantly discriminated AKI (area under the receiver operating characteristic [ROC] curve: BNP: 0.86, sST2: 0.74, NGAL: 0.75, cystatin C: 0.73; all P < 0.05). Elevation of ≥2 of the biomarkers higher than the cutoff values derived from the ROC analysis improved AKI risk stratification, regardless of the creatine level (creatinine < 1.24 mg/dL: odds ratio [OR] 11.25, 95% confidence interval [CI] 1.63-77.92, P = 0.014; creatinine ≥ 1.24: OR 15.0, 95% CI 1.23-183.6, P = 0.034).

Conclusions: In this study of STEMI patients undergoing primary PCI, the biomarkers of heart failure (BNP and sST2) and renal injury (NGAL and cystatin C) at presentation were predictive of AKI. High serum levels of the biomarkers were associated with an elevated risk and more advanced stage of AKI. Regardless of the creatinine level, elevation of ≥2 of the biomarkers higher than the cutoff values indicated a further rise in AKI risk. Combined biomarker approach may assist in risk stratification of AKI in patients with STEMI.

No MeSH data available.


Related in: MedlinePlus