Acute Kidney Injury Biomarkers for Patients in a Coronary Care Unit: A Prospective Cohort Study

Background/Aims: Acute Kidney Injury (AKI) is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC) is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU) patients. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients’ hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. Results: According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6%) patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842)] outperformed β2-micro globulin (AUC=0.813) and the clinical model (AUC=0.777), and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2%) patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR), 4.955; 95% confidence interval (95% CI), 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867), as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463). Conclusions: Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

Hu¹,

Liu²,

Du³

et al. 2017

“…Shacham Y et al [30] identified that hs-CRP was an independent predictor of AKI in ST elevation myocardial infarction patients undergoing primary percutaneous intervention. However, Chen TH et al [31] found that hs-CRP was not an independent predictor of AKI in patients admitted to the coronary care unit, though patients who developed AKI were with higher hs-CRP levels. In the present study, hs-CRP was of predictive significance for CRS1 in AHF patients.…”

Section: Clinical Application Of the Nomogrammentioning

confidence: 96%

Nomogram Model to Predict Cardiorenal Syndrome Type 1 in Patients with Acute Heart Failure

Fan

Yang

et al. 2018

Background/Aims: Cardiorenal syndrome type 1(CRS1) is a serious clinical condition in patients with acute heart failure (AHF) associated with adverse clinical outcomes. Although several biomarkers for identifying CRS1 have been reported, early and accurate predicting CRS1 still remains a challenge. This study was aimed to develop and validate an individualized predictive nomogram for the risk of CRS1 in patients with AHF. Methods: A total of 1235 AHF patients between 2013 and 2018 were included in this study. The patients were randomly classified into training set (n=823) and validation set (n=412). All data of the training set were used to screen the predictors of CRS1 via univariate and multivariate analyses. A nomogram was developed based on these predictors and validated by internal and external validation. The nomogram validation comprised discriminative ability determined by the area under the curve (AUC) of receiver-operating characteristic (ROC) curve and the predictive accuracy by calibration plots. Results: The overall incidence of CRS1 was 31.7%. Multivariate logistic regression revealed that age, diabetes, NYHA class, eGFR, hs-CRP and uAGT were independently associated with CRS1. A nomogram developed based on the six variables was with the AUC 0.885 and 0.823 on internal and external validation, respectively. Calibration plots showed that the predicted and actual CRS1 probabilities were fitted well on both internal and external validation. Conclusion: The proposed nomogram could predict the individualized risk of CRS1 with good accuracy, high discrimination, and potential clinical applicability in patients with AHF.

“…Analysis of pooled data from 2322 critically ill patients revealed that in a group of patients without of AKI (according to conventional definition based on increased level of serum creatinine) elevated levels of NGAL identified patients with increased risk of subsequent renal replacement therapy (0.0015% vs 2.5% ;odds ratio 16.4, p < 0.001) and hospital mortality (4.8% vs 12.4%) [20]. In the absence of diagnostic increases in serum creatinine, NGAL so detects patients with likely subclinical AKI and increased risk of adverse outcomes [21,22,23,24]. …”

Section: Ngal - a Biomarker Of Kidney Injurymentioning

confidence: 99%

Diagnostic and Prognostic Utility of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Patients with Cardiovascular Diseases - Review

Helánová

Špinar²,

Pařenica³

2014

NGAL (neutrophil gelatinase-associated lipocalin) is an acute phase protein, participating in antibacterial immunity. NGAL forms a complex with metalloproteinase 9 (MMP-9), thereby increasing its activity and preventing its degradation. NGAL is freely filtered through the glomerular membrane and reabsorbed by endocytosis in the proximal tubule. NGAL detected in urine is produced mainly in the distal nephron. Elevated serum and urine NGAL allows diagnosis of acute kidney injury approximately 24 hours earlier than plasma creatinine concentration. Increased levels of NGAL were detected in patients with acute myocardial infarction, heart failure or stroke and were demonstrated to be strong predictors of adverse prognosis.