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Impact of clinical context on acute kidney injury biomarker performances: differences between neutrophil gelatinase-associated lipocalin and L-type fatty acid-binding protein

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ABSTRACT

Application of acute kidney injury (AKI) biomarkers with consideration of nonrenal conditions and systemic severity has not been sufficiently determined. Herein, urinary neutrophil gelatinase-associated lipocalin (NGAL), L-type fatty acid-binding protein (L-FABP) and nonrenal disorders, including inflammation, hypoperfusion and liver dysfunction, were evaluated in 249 critically ill patients treated at our intensive care unit. Distinct characteristics of NGAL and L-FABP were revealed using principal component analysis: NGAL showed linear correlations with inflammatory markers (white blood cell count and C-reactive protein), whereas L-FABP showed linear correlations with hypoperfusion and hepatic injury markers (lactate, liver transaminases and bilirubin). We thus developed a new algorithm by combining urinary NGAL and L-FABP with stratification by the Acute Physiology and Chronic Health Evaluation score, presence of sepsis and blood lactate levels to improve their AKI predictive performance, which showed a significantly better area under the receiver operating characteristic curve [AUC-ROC 0.940; 95% confidential interval (CI) 0.793–0.985] than that under NGAL alone (AUC-ROC 0.858, 95% CI 0.741–0.927, P = 0.03) or L-FABP alone (AUC-ROC 0.837, 95% CI 0.697–0.920, P = 0.007) and indicated that nonrenal conditions and systemic severity should be considered for improved AKI prediction by NGAL and L-FABP as biomarkers.

No MeSH data available.


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Study flow diagram.ESRD, end-stage renal disease.
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f1: Study flow diagram.ESRD, end-stage renal disease.

Mentions: A total of 249 patients admitted to our hospital between April 2010 and March 2011 were eligible for analysis (Fig. 1). Of these, 34 patients were diagnosed with chronic kidney disease (CKD) before admission to the intensive care unit (ICU). Additionally, 147 patients (59.0%) were diagnosed with AKI within the first 7 days of ICU admission, 116 of whom had already developed AKI at the time of ICU admission. Fifty-four patients were treated with renal replacement therapy. The in-hospital mortality rate of AKI patients was 19%. Among 147 AKI patients, 10 patients proceeded to CKD, and 9 patients eventually required chronic haemodialysis. Baseline characteristics of the patients with newly developed AKI after ICU admission (n = 31) and those who did not develop AKI during the first 7 days (n = 102) are shown in Table 1.


Impact of clinical context on acute kidney injury biomarker performances: differences between neutrophil gelatinase-associated lipocalin and L-type fatty acid-binding protein
Study flow diagram.ESRD, end-stage renal disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015077&req=5

f1: Study flow diagram.ESRD, end-stage renal disease.
Mentions: A total of 249 patients admitted to our hospital between April 2010 and March 2011 were eligible for analysis (Fig. 1). Of these, 34 patients were diagnosed with chronic kidney disease (CKD) before admission to the intensive care unit (ICU). Additionally, 147 patients (59.0%) were diagnosed with AKI within the first 7 days of ICU admission, 116 of whom had already developed AKI at the time of ICU admission. Fifty-four patients were treated with renal replacement therapy. The in-hospital mortality rate of AKI patients was 19%. Among 147 AKI patients, 10 patients proceeded to CKD, and 9 patients eventually required chronic haemodialysis. Baseline characteristics of the patients with newly developed AKI after ICU admission (n = 31) and those who did not develop AKI during the first 7 days (n = 102) are shown in Table 1.

View Article: PubMed Central - PubMed

ABSTRACT

Application of acute kidney injury (AKI) biomarkers with consideration of nonrenal conditions and systemic severity has not been sufficiently determined. Herein, urinary neutrophil gelatinase-associated lipocalin (NGAL), L-type fatty acid-binding protein (L-FABP) and nonrenal disorders, including inflammation, hypoperfusion and liver dysfunction, were evaluated in 249 critically ill patients treated at our intensive care unit. Distinct characteristics of NGAL and L-FABP were revealed using principal component analysis: NGAL showed linear correlations with inflammatory markers (white blood cell count and C-reactive protein), whereas L-FABP showed linear correlations with hypoperfusion and hepatic injury markers (lactate, liver transaminases and bilirubin). We thus developed a new algorithm by combining urinary NGAL and L-FABP with stratification by the Acute Physiology and Chronic Health Evaluation score, presence of sepsis and blood lactate levels to improve their AKI predictive performance, which showed a significantly better area under the receiver operating characteristic curve [AUC-ROC 0.940; 95% confidential interval (CI) 0.793–0.985] than that under NGAL alone (AUC-ROC 0.858, 95% CI 0.741–0.927, P = 0.03) or L-FABP alone (AUC-ROC 0.837, 95% CI 0.697–0.920, P = 0.007) and indicated that nonrenal conditions and systemic severity should be considered for improved AKI prediction by NGAL and L-FABP as biomarkers.

No MeSH data available.


Related in: MedlinePlus