Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

Isaac E. Hall, Steven G. Coca, Mark A. Perazella, Umo U. Eko, Randy L. Luciano, Patricia R. Peter, Won K. Han, Chirag Parikh

Research output: Contribution to journalArticle

Abstract

Background and objectives Studies have evaluated acute kidney injury (AKI) using biomarkers in various settings, but their prognostic utility within current practice is unclear. Thus, we sought to determine the prognostic utility of newer biomarkers or traditional markers (fractional excretion of sodium [FeNa] and urea [FeUrea] and microscopy) over clinical assessment alone. Design, setting, participants, & measurements This is a prospective cohort study of adults on the first day of meeting AKI criteria. We measured urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and IL-18 and determined FeNa, FeUrea, and microscopy score for casts and tubular cells. Primary outcome was worsened AKI stage from enrollment to peak serum creatinine or in-hospital death. Results In 249 recipients, 57% were ≥65 years old, 48% were from intensive care, and mean baseline GFR was 69 ± 30 ml/min per 1.73 m 2. AKI was considered prerenal in 164 (66%), acute tubular necrosis (ATN) in 51 (20%), and "other" in 34 (14%). All mean protein biomarker concentrations, FeNa, FeUrea, and microscopy scores were statistically different between prerenal and ATN. Seventy-two patients (29%) developed the primary outcome. There was an approximate three-fold increase in adjusted risk for the outcome for upper versus lower values of NGAL, KIM-1, IL-18, and microscopy score (P values <0.05). Net reclassification improved after adding these to baseline clinical assessment. FeNa and FeUrea were not useful. Conclusions On the first day of AKI, urine protein biomarkers and microscopy significantly improve upon clinical determination of prognosis, indicating their potential utility in current practice.

Original languageEnglish (US)
Pages (from-to)2740-2749
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2011

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Acute Kidney Injury
Microscopy
Biomarkers
Urea
Interleukin-18
Necrosis
Urine
Kidney
Wounds and Injuries
Critical Care
Creatinine
Proteins
Cohort Studies
Sodium
Prospective Studies
Serum
Lipocalin-2

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis. / Hall, Isaac E.; Coca, Steven G.; Perazella, Mark A.; Eko, Umo U.; Luciano, Randy L.; Peter, Patricia R.; Han, Won K.; Parikh, Chirag.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 12, 01.12.2011, p. 2740-2749.

Research output: Contribution to journalArticle

Hall, Isaac E. ; Coca, Steven G. ; Perazella, Mark A. ; Eko, Umo U. ; Luciano, Randy L. ; Peter, Patricia R. ; Han, Won K. ; Parikh, Chirag. / Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 12. pp. 2740-2749.
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