Abstract:
OBJECTIVES:This study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department. BACKGROUND:Intrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI. METHODS:In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization. RESULTS:All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events. CONCLUSIONS:Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Nickolas TL,Schmidt-Ott KM,Canetta P,Forster C,Singer E,Sise M,Elger A,Maarouf O,Sola-Del Valle DA,O'Rourke M,Sherman E,Lee P,Geara A,Imus P,Guddati A,Polland A,Rahman W,Elitok S,Malik N,Giglio J,El-Sayegh S,Devdoi
10.1016/j.jacc.2011.10.854subject
Has Abstractpub_date
2012-01-17 00:00:00pages
246-55issue
3eissn
0735-1097issn
1558-3597pii
S0735-1097(11)04654-7journal_volume
59pub_type
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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更新日期:1984-02-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:1984-07-01 00:00:00