Urinary biomarkers of AKI and mortality 3 years after cardiac surgery

Steven G. Coca, Amit X. Garg, Heather Thiessen-Philbrook, Jay L. Koyner, Uptal D. Patel, Harlan M. Krumholz, Michael G. Shlipak, Chirag R. Parikh, Jai Raman, Valluvan Jeevanandam, Shahab Akhter, Prasad Devarajan, Michael Bennett, Qing Ma, Rachel Griffiths, Charles Edelstein, Cary Passik, Judy Nagy, Madhav Swaminathan, Michael ChuMartin Goldbach, Lin Ruo Guo, Neil McKenzie, Mary Lee Myers, Richard Novick, Mac Quantz, Virginia Schumann, Laura Webster, Michael Zappitelli, Ana Palijan, Michael Dewar, Umer Darr, Sabet Hashim, John Elefteriades, Arnar Geirsson, Susan Garwood, Rowena Kemp, Isabel Butrymowicz

Research output: Contribution to journalArticle

Abstract

Urinary biomarkers ofAKI provide prognostic value for in-hospital outcomes, but little is known about their association with longer-term mortality after surgery.We sought to assess the association between kidney injury biomarkers and all-cause mortality in an international,multicenter, prospective long-term follow-up study from six clinical centers in the United States and Canada composed of 1199 adults who underwent cardiac surgery between 2007 and 2009 and were enrolled in the Translational Research in Biomarker Endpoints in AKI cohort. On postoperative days 1-3, we measured the following five urinary biomarkers: neutrophil gelatinase-associated lipocalin, IL-18, kidney injury molecule-1 (KIM-1), liver fatty acid binding protein, and albumin. During a median follow-up of 3.0 years (interquartile range, 2.2-3.6 years), 139 participants died (55 deaths per 1000 person-years). Among patients with clinical AKI, the highest tertiles of peak urinary neutrophil gelatinase-associated lipocalin, IL-18, KIM-1, liver fatty acid binding protein, and albumin associated independently with a 2.0-to 3.2-fold increased risk for mortality compared with the lowest tertiles. In patients without clinical AKI, the highest tertiles of peak IL-18 and KIM-1 also associated independently with long-term mortality (adjusted hazard ratios [95% confidence intervals] of 1.2 [1.0 to 1.5] and 1.8 [1.4 to 2.3] for IL-18 and KIM-1, respectively), and yielded continuous net reclassification improvements of 0.26 and 0.37, respectively, for the prediction of 3-year mortality. In conclusion, urinary biomarkers of kidney injury, particularly IL-18 and KIM-1, in the immediate postoperative period provide additional prognostic information for 3-year mortality risk in patients with and without clinical AKI.

Original languageEnglish (US)
Pages (from-to)1063-1071
Number of pages9
JournalJournal of the American Society of Nephrology
Volume25
Issue number5
DOIs
StatePublished - May 1 2014

ASJC Scopus subject areas

  • Nephrology

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    Coca, S. G., Garg, A. X., Thiessen-Philbrook, H., Koyner, J. L., Patel, U. D., Krumholz, H. M., Shlipak, M. G., Parikh, C. R., Raman, J., Jeevanandam, V., Akhter, S., Devarajan, P., Bennett, M., Ma, Q., Griffiths, R., Edelstein, C., Passik, C., Nagy, J., Swaminathan, M., ... Butrymowicz, I. (2014). Urinary biomarkers of AKI and mortality 3 years after cardiac surgery. Journal of the American Society of Nephrology, 25(5), 1063-1071. https://doi.org/10.1681/ASN.2013070742