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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

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.

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Principal component analysis of acute kidney injury (AKI) biomarkers and systemic parameters.Principal component analysis revealed different orthogonal directions between urinary NGAL and L-FABP.
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f2: Principal component analysis of acute kidney injury (AKI) biomarkers and systemic parameters.Principal component analysis revealed different orthogonal directions between urinary NGAL and L-FABP.

Mentions: To examine whether changes in urinary NGAL and L-FABP levels were distinct in relation to nonrenal disorders, we evaluated their relationship with C-reactive protein levels and white blood cell counts for systemic inflammation2627, blood lactate levels for hypoperfusion2829 as well as aspartate aminotransferase, alanine aminotransferase and total bilirubin levels for hepatic injury303132 using principal component analysis33 in all 249 patients. The results of the principal component analysis showed distinct relationships between NGAL and L-FABP and the interrogated variables (Fig. 2). NGAL showed linear correlations with inflammatory indicators and was perpendicular to L-FABP, which was linearly correlated with both hypoperfusion and hepatic injury markers. In addition, the serum creatinine level showed a linear correlation with NGAL. The correlation between NGAL and C-reactive protein level was the strongest, with a correlation coefficient of 0.50 [95% confidence interval (CI) 0.41–0.59]. These distinctive characteristics of NGAL and L-FABP were preserved when AKI and non-AKI patients were separately analysed.


Impact of clinical context on acute kidney injury biomarker performances: differences between neutrophil gelatinase-associated lipocalin and L-type fatty acid-binding protein
Principal component analysis of acute kidney injury (AKI) biomarkers and systemic parameters.Principal component analysis revealed different orthogonal directions between urinary NGAL and L-FABP.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2: Principal component analysis of acute kidney injury (AKI) biomarkers and systemic parameters.Principal component analysis revealed different orthogonal directions between urinary NGAL and L-FABP.
Mentions: To examine whether changes in urinary NGAL and L-FABP levels were distinct in relation to nonrenal disorders, we evaluated their relationship with C-reactive protein levels and white blood cell counts for systemic inflammation2627, blood lactate levels for hypoperfusion2829 as well as aspartate aminotransferase, alanine aminotransferase and total bilirubin levels for hepatic injury303132 using principal component analysis33 in all 249 patients. The results of the principal component analysis showed distinct relationships between NGAL and L-FABP and the interrogated variables (Fig. 2). NGAL showed linear correlations with inflammatory indicators and was perpendicular to L-FABP, which was linearly correlated with both hypoperfusion and hepatic injury markers. In addition, the serum creatinine level showed a linear correlation with NGAL. The correlation between NGAL and C-reactive protein level was the strongest, with a correlation coefficient of 0.50 [95% confidence interval (CI) 0.41–0.59]. These distinctive characteristics of NGAL and L-FABP were preserved when AKI and non-AKI patients were separately analysed.

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