Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.

Parr SK, Clark AJ, Bian A, Shintani AK, Wickersham NE, Ware LB, Ikizler TA, Siew ED
Kidney Int. 2015 87 (3): 640-8

PMID: 25229339 · PMCID: PMC4344867 · DOI:10.1038/ki.2014.301

Biomarker studies for early detection of acute kidney injury (AKI) have been limited by nonselective testing and uncertainties in using small changes in serum creatinine as a reference standard. Here we examine the ability of urine L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) to predict injury progression, dialysis, or death within 7 days in critically ill adults with early AKI. Of 152 patients with known baseline creatinine examined, 36 experienced the composite outcome. Urine L-FABP demonstrated an area under the receiver-operating characteristic curve (AUC-ROC) of 0.79 (95% confidence interval 0.70-0.86), which improved to 0.82 (95% confidence interval 0.75-0.90) when added to the clinical model (AUC-ROC of 0.74). Urine NGAL, IL-18, and KIM-1 had AUC-ROCs of 0.65, 0.64, and 0.62, respectively, but did not significantly improve discrimination of the clinical model. The category-free net reclassification index improved with urine L-FABP (total net reclassification index for nonevents 31.0%) and urine NGAL (total net reclassification index for events 33.3%). However, only urine L-FABP significantly improved the integrated discrimination index. Thus, modest early changes in serum creatinine can help target biomarker measurement for determining prognosis with urine L-FABP, providing independent and additive prognostic information when combined with clinical predictors.

MeSH Terms (25)

Acute-Phase Proteins Acute Kidney Injury Aged APACHE Area Under Curve Biomarkers Creatinine Critical Illness Disease Progression Early Diagnosis Fatty Acid-Binding Proteins Female Hepatitis A Virus Cellular Receptor 1 Humans Interleukin-18 Lipocalin-2 Lipocalins Male Membrane Glycoproteins Middle Aged Predictive Value of Tests Proto-Oncogene Proteins Receptors, Virus Renal Dialysis ROC Curve

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