TY - JOUR
T1 - Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage
T2 - A multicenter prospective cohort study
AU - Nickolas, Thomas L.
AU - Schmidt-Ott, Kai M.
AU - Canetta, Pietro
AU - Forster, Catherine
AU - Singer, Eugenia
AU - Sise, Meghan
AU - Elger, Antje
AU - Maarouf, Omar
AU - Sola-Del Valle, David Antonio
AU - O'Rourke, Matthew
AU - Sherman, Evan
AU - Lee, Peter
AU - Geara, Abdallah
AU - Imus, Philip
AU - Guddati, Achuta
AU - Polland, Allison
AU - Rahman, Wasiq
AU - Elitok, Saban
AU - Malik, Nasir
AU - Giglio, James
AU - El-Sayegh, Suzanne
AU - Devarajan, Prasad
AU - Hebbar, Sudarshan
AU - Saggi, Subodh J.
AU - Hahn, Barry
AU - Kettritz, Ralph
AU - Luft, Friedrich C.
AU - Barasch, Jonathan
PY - 2012/1/17
Y1 - 2012/1/17
N2 - 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. 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. In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinaseassociated 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. All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinaseassociated 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 gelatinaseassociated 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. Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.
AB - 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. 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. In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinaseassociated 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. All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinaseassociated 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 gelatinaseassociated 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. Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.
KW - acute kidney injury
KW - biomarkers
KW - outcomes
UR - https://www.scopus.com/pages/publications/84855707707
U2 - 10.1016/j.jacc.2011.10.854
DO - 10.1016/j.jacc.2011.10.854
M3 - Article
C2 - 22240130
AN - SCOPUS:84855707707
SN - 0735-1097
VL - 59
SP - 246
EP - 255
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -