Urinary biomarkers and progression of AKI in patients with cirrhosis

The TRIBE-AKI Consortium

Research output: Contribution to journalArticle

Abstract

Background and objectives AKI is a common and severe complication in patientswith cirrhosis. AKI progression was previously shown to correlate with in-hospital mortality. Therefore, accurately predicting which patients are at highest risk for AKI progression may allow more rapid and targeted treatment. Urinary biomarkers of structural kidney injury associate with AKI progression and mortality in multiple settings of AKI but their prognostic performance in patients with liver cirrhosis is not well known. Design, setting, participants, & measurements A multicenter, prospective cohort study was conducted at four tertiary care United States medical centers between 2009 and 2011. The study comprised patients with cirrhosis and AKI defined by the AKI Network criteria evaluating structural (neutrophil gelatinase–associated lipocalin, IL-18, kidney injury molecule-1 [KIM-1], liver-type fatty acid–binding protein [L-FABP], and albuminuria) and functional (fractional excretion of sodium [FENa]) urinary biomarkers as predictors of AKI progression and in hospital mortality. Results Of 188 patients in the study, 44 (23%) experienced AKI progression alone and 39 (21%) suffered both progression and death during their hospitalization. Neutrophil gelatinase–associated lipocalin, IL-18, KIM-1, L-FABP, and albuminuria were significantly higher in patients with AKI progression and death. These biomarkers were independently associatedwith this outcome after adjusting for key clinical variables includingmodel of end stage liver disease score, IL-18 (relative risk [RR], 4.09; 95% confidence interval [95% CI], 1.56 to 10.70), KIM-1(RR, 3.13; 95% CI, 1.20 to 8.17), L-FABP (RR, 3.43; 95% CI, 1.54 to 7.64), and albuminuria (RR, 2.07; 95% CI, 1.05–4.10) per log change. No biomarkers were independently associated with progression without mortality. FENa demonstrated no association with worsening of AKI. When added to a robust clinical model, only IL-18 independently improved risk stratification on a net reclassification index. Conclusions Multiple structural biomarkers of kidney injury, but not FENa, are independently associated with progression of AKI and mortality in patients with cirrhosis. Injury marker levels were similar between those without progression and those with progression alone.

Original languageEnglish (US)
Pages (from-to)1857-1867
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume9
Issue number11
DOIs
StatePublished - Jan 1 2015

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Interleukin-18
Fibrosis
Biomarkers
Albuminuria
Kidney
Wounds and Injuries
Fatty Liver
Confidence Intervals
Lipocalins
Hospital Mortality
Mortality
Neutrophils
End Stage Liver Disease
Proteins
Tertiary Healthcare
Liver Cirrhosis
Hospitalization
Cohort Studies
Sodium
Prospective Studies

ASJC Scopus subject areas

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

Cite this

Urinary biomarkers and progression of AKI in patients with cirrhosis. / The TRIBE-AKI Consortium.

In: Clinical Journal of the American Society of Nephrology, Vol. 9, No. 11, 01.01.2015, p. 1857-1867.

Research output: Contribution to journalArticle

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abstract = "Background and objectives AKI is a common and severe complication in patientswith cirrhosis. AKI progression was previously shown to correlate with in-hospital mortality. Therefore, accurately predicting which patients are at highest risk for AKI progression may allow more rapid and targeted treatment. Urinary biomarkers of structural kidney injury associate with AKI progression and mortality in multiple settings of AKI but their prognostic performance in patients with liver cirrhosis is not well known. Design, setting, participants, & measurements A multicenter, prospective cohort study was conducted at four tertiary care United States medical centers between 2009 and 2011. The study comprised patients with cirrhosis and AKI defined by the AKI Network criteria evaluating structural (neutrophil gelatinase–associated lipocalin, IL-18, kidney injury molecule-1 [KIM-1], liver-type fatty acid–binding protein [L-FABP], and albuminuria) and functional (fractional excretion of sodium [FENa]) urinary biomarkers as predictors of AKI progression and in hospital mortality. Results Of 188 patients in the study, 44 (23{\%}) experienced AKI progression alone and 39 (21{\%}) suffered both progression and death during their hospitalization. Neutrophil gelatinase–associated lipocalin, IL-18, KIM-1, L-FABP, and albuminuria were significantly higher in patients with AKI progression and death. These biomarkers were independently associatedwith this outcome after adjusting for key clinical variables includingmodel of end stage liver disease score, IL-18 (relative risk [RR], 4.09; 95{\%} confidence interval [95{\%} CI], 1.56 to 10.70), KIM-1(RR, 3.13; 95{\%} CI, 1.20 to 8.17), L-FABP (RR, 3.43; 95{\%} CI, 1.54 to 7.64), and albuminuria (RR, 2.07; 95{\%} CI, 1.05–4.10) per log change. No biomarkers were independently associated with progression without mortality. FENa demonstrated no association with worsening of AKI. When added to a robust clinical model, only IL-18 independently improved risk stratification on a net reclassification index. Conclusions Multiple structural biomarkers of kidney injury, but not FENa, are independently associated with progression of AKI and mortality in patients with cirrhosis. Injury marker levels were similar between those without progression and those with progression alone.",
author = "{The TRIBE-AKI Consortium} and Belcher, {Justin M.} and Guadalupe Garcia-Tsao and Sanyal, {Arun J.} and {Thiessen Philbrook}, Heather and Peixoto, {Aldo J.} and Perazella, {Mark A.} and Naheed Ansari and Joseph Lim and Coca, {Steven G.} and Chirag Parikh",
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AU - Thiessen Philbrook, Heather

AU - Peixoto, Aldo J.

AU - Perazella, Mark A.

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