Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery.

Arthur JM, Hill EG, Alge JL, Lewis EC, Neely BA, Janech MG, Tumlin JA, Chawla LS, Shaw AD, SAKInet Investigators
Kidney Int. 2014 85 (2): 431-8

PMID: 24005224 · PMCID: PMC3880389 · DOI:10.1038/ki.2013.333

Biomarkers for acute kidney injury (AKI) have been used to predict the progression of AKI, but a systematic comparison of the prognostic ability of each biomarker alone or in combination has not been performed. In order to assess this, we measured the concentration of 32 candidate biomarkers in the urine of 95 patients with AKIN stage 1 after cardiac surgery. Urine markers were divided into eight groups based on the putative pathophysiological mechanism they reflect. We then compared the ability of the markers alone or in combination to predict the primary outcome of worsening AKI or death (23 patients) and the secondary outcome of AKIN stage 3 or death (13 patients). IL-18 was the best predictor of both outcomes (AUC of 0.74 and 0.89). L-FABP (AUC of 0.67 and 0.85), NGAL (AUC of 0.72 and 0.83), and KIM-1 (AUC of 0.73 and 0.81) were also good predictors. Correlation between most of the markers was generally related to their predictive ability, but KIM-1 had a relatively weak correlation with other markers. The combination of IL-18 and KIM-1 had a very good predictive value with an AUC of 0.93 to predict AKIN 3 or death. Thus, a combination of IL-18 and KIM-1 would result in improved identification of high-risk patients for enrollment in clinical trials.

MeSH Terms (25)

Acute Kidney Injury Adult Aged Aged, 80 and over Area Under Curve Biomarkers Cardiac Surgical Procedures Disease Progression Female Hepatitis A Virus Cellular Receptor 1 Humans Interleukin-18 Male Membrane Glycoproteins Middle Aged Predictive Value of Tests Prognosis Receptors, Virus Risk Assessment Risk Factors ROC Curve Severity of Illness Index Time Factors United States Urinalysis

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