Assessment of biochemical markers in the early post-burn period for predicting acute kidney injury and mortality in patients with major burn injury: comparison of serum creatinine, serum cystatin-C, plasma and urine neutrophil gelatinase-associated lipocalin

Abstract

IntroductionThe reported mortality rates range from 28% to 100% in burn patients who develop acute kidney injury (AKI) and from 50% to 100% among such patients treated with renal replacement therapy. Recently, the serum cystatin C and plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) levels have been introduced as early biomarkers for AKI; the levels of these biomarkers are known to increase 24 to 48 hours before the serum creatinine levels increase. In this study, we aimed to estimate the diagnostic utility of the cystatin C and plasma and urine NGAL levels in the early post-burn period as biomarkers for predicting AKI and mortality in patients with major burn injuries.MethodsFrom May 2011 to July 2012, 90 consecutive patients with a burn wound area comprising ≥ 20% of the total body surface area (TBSA) were enrolled in this study. Whole blood and urine samples were obtained for measuring the serum creatinine, serum cystatin C, and urine and plasma NGAL levels at 0, 3, 6, 12, 24, and 48 hours after admission. Receiver operating characteristic curve, area under the curve, and multivariate logistic regression analyses were performed to assess the predictive values of these biomarkers for AKI and mortality.ResultsIn the multivariate logistic regression analysis, all variables, including age, percentage TBSA burned, sex, inhalation injury, and serum creatinine levels, serum cystatin C levels, and plasma and urine NGAL levels were independently associated with AKI development. Moreover, age, sex, percentage TBSA burned, and plasma and urine NGAL levels were independently associated with mortality. However, inhalation injury and the serum creatinine and cystatin C levels were not independently associated with mortality.ConclusionsMassively burned patients who maintained high plasma and urine NGAL levels until 12 hours after admission were at the risk of developing early AKI and early mortality with burn shock. However, the plasma and urine NGAL levels in the early post-burn period failed to predict late AKI and non-burn shock mortality in this study. Nevertheless, the plasma and urine NGAL levels were independently associated with AKI development and mortality within 48 hours after admission.

Predictive value of serum cystatin C for acute kidney injury in adults: a meta-analysis of prospective cohort trials

“…Thirty studies161718192021222324252627282930313233343536373839404142434445 finally met the inclusion criteria via full-text evaluation from 156 potentially eligible citations. Seven studies21222324252627 were selected from the previous meta-analysis (Zhang, et al .…”

“…Seven studies21222324252627 were selected from the previous meta-analysis (Zhang, et al . 2011)15 and an additional 23 studies1617181920282930313233343536373839404142434445 were complemented in the present meta-analysis. A flow chart of the identification and selection process is shown in Fig.…”

EGF Receptor Inhibition Alleviates Hyperuricemic Nephropathy

“…49,50 Thus, we also examined the effect of EGFR blockade on its expression in the kidney of hyperuricemic rats. Immunohistochemistry staining showed that Lcn2 expression was barely seen in the kidney of sham-operated kidney with or without administration of gefitinib, but it was clearly expressed in renal tubules of HN.…”

Urinary Biomarkers are Associated with Severity and Mechanism of Injury

“…Urinary NGAL has been associated with AKI in critically ill trauma patients (27). Both plasma and urine NGAL have also been associated with AKI in patients with burn injury (11, 12). Serum NGAL has been associated with mortality and renal failure in combat casualties (28).…”

“…Burn injury was coined the “universal trauma model” by Dr Basil Pruitt (10). Notably, both serum and urine NGAL levels correlate with burn severity (11, 12). Comparing UB elevations in civilian populations with and without burn injury, and comparing UB patterns to combat casualties with explosive injuries, would provide evidence that the burn population can serve as a surrogate for future studies.…”