Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units

Hiroyuki Naruse, Junichi Ishii, Hiroshi Takahashi, Fumihiko Kitagawa, Hideto Nishimura, Hideki Kawai, Takashi Muramatsu, Masahide Harada, Akira Yamada, Sadako Motoyama, Shigeru Matsui, Mutsuharu Hayashi, Masayoshi Sarai, Eiichi Watanabe, Hideo Izawa, Yukio Ozaki

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The early prediction of acute kidney injury (AKI) can facilitate timely intervention and prevent complications. We aimed to understand the predictive value of urinary liver-type fatty-acid binding protein (L-FABP) levels on admission to medical (non-surgical) cardiac intensive care units (CICUs) for AKI, both independently and in combination with serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Methods: We prospectively investigated the predictive value of L-FABP and NT-proBNP for AKI in a large, heterogeneous cohort of patients treated in medical CICUs. Baseline urinary L-FABP and serum NT-proBNP were measured on admission. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. We studied 1273 patients (mean age, 68years), among whom 46% had acute coronary syndromes, 38% had acute decompensated heart failure, 5% had arrhythmia, 3% had pulmonary hypertension, 2% had acute aortic syndrome, 2% had infective endocarditis, and 1% had Takotsubo cardiomyopathy. Results: Urinary L-FABP levels correlated with serum NT-proBNP levels (r=0.17, p<0.0001). AKI occurred in 224 patients (17.6%), including 48 patients with stage 2 or 3 disease. Patients who developed AKI had higher one-week and 6-month mortality than those who did not develop AKI (p=0.0002 and p=0.003, respectively). In the multivariate logistic analysis, both L-FABP (p<0.0001) and NT-proBNP (p=0.006) were independently associated with the development of AKI. Adding L-FABP and NT-proBNP to a baseline model that included established risk factors further improved reclassification (p<0.001) and discrimination (p<0.01) beyond that of the baseline model or any single biomarker individually. Conclusions: Urinary L-FABP and serum NT-proBNP levels on admission are independent predictors of AKI, and when used in combination, improve early prediction of AKI in patients hospitalized at medical CICUs.

Original languageEnglish
Article number197
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - 18-08-2018

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Fatty Acid-Binding Proteins
Brain Natriuretic Peptide
Acute Kidney Injury
Intensive Care Units
Serum
Takotsubo Cardiomyopathy
Kidney Diseases
Acute Coronary Syndrome
Endocarditis
Pulmonary Hypertension
Cardiac Arrhythmias
Multivariate Analysis
Heart Failure
Biomarkers

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Naruse, Hiroyuki ; Ishii, Junichi ; Takahashi, Hiroshi ; Kitagawa, Fumihiko ; Nishimura, Hideto ; Kawai, Hideki ; Muramatsu, Takashi ; Harada, Masahide ; Yamada, Akira ; Motoyama, Sadako ; Matsui, Shigeru ; Hayashi, Mutsuharu ; Sarai, Masayoshi ; Watanabe, Eiichi ; Izawa, Hideo ; Ozaki, Yukio. / Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units. In: Critical Care. 2018 ; Vol. 22, No. 1.
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abstract = "Background: The early prediction of acute kidney injury (AKI) can facilitate timely intervention and prevent complications. We aimed to understand the predictive value of urinary liver-type fatty-acid binding protein (L-FABP) levels on admission to medical (non-surgical) cardiac intensive care units (CICUs) for AKI, both independently and in combination with serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Methods: We prospectively investigated the predictive value of L-FABP and NT-proBNP for AKI in a large, heterogeneous cohort of patients treated in medical CICUs. Baseline urinary L-FABP and serum NT-proBNP were measured on admission. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. We studied 1273 patients (mean age, 68years), among whom 46{\%} had acute coronary syndromes, 38{\%} had acute decompensated heart failure, 5{\%} had arrhythmia, 3{\%} had pulmonary hypertension, 2{\%} had acute aortic syndrome, 2{\%} had infective endocarditis, and 1{\%} had Takotsubo cardiomyopathy. Results: Urinary L-FABP levels correlated with serum NT-proBNP levels (r=0.17, p<0.0001). AKI occurred in 224 patients (17.6{\%}), including 48 patients with stage 2 or 3 disease. Patients who developed AKI had higher one-week and 6-month mortality than those who did not develop AKI (p=0.0002 and p=0.003, respectively). In the multivariate logistic analysis, both L-FABP (p<0.0001) and NT-proBNP (p=0.006) were independently associated with the development of AKI. Adding L-FABP and NT-proBNP to a baseline model that included established risk factors further improved reclassification (p<0.001) and discrimination (p<0.01) beyond that of the baseline model or any single biomarker individually. Conclusions: Urinary L-FABP and serum NT-proBNP levels on admission are independent predictors of AKI, and when used in combination, improve early prediction of AKI in patients hospitalized at medical CICUs.",
author = "Hiroyuki Naruse and Junichi Ishii and Hiroshi Takahashi and Fumihiko Kitagawa and Hideto Nishimura and Hideki Kawai and Takashi Muramatsu and Masahide Harada and Akira Yamada and Sadako Motoyama and Shigeru Matsui and Mutsuharu Hayashi and Masayoshi Sarai and Eiichi Watanabe and Hideo Izawa and Yukio Ozaki",
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Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units. / Naruse, Hiroyuki; Ishii, Junichi; Takahashi, Hiroshi; Kitagawa, Fumihiko; Nishimura, Hideto; Kawai, Hideki; Muramatsu, Takashi; Harada, Masahide; Yamada, Akira; Motoyama, Sadako; Matsui, Shigeru; Hayashi, Mutsuharu; Sarai, Masayoshi; Watanabe, Eiichi; Izawa, Hideo; Ozaki, Yukio.

In: Critical Care, Vol. 22, No. 1, 197, 18.08.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units

AU - Naruse, Hiroyuki

AU - Ishii, Junichi

AU - Takahashi, Hiroshi

AU - Kitagawa, Fumihiko

AU - Nishimura, Hideto

AU - Kawai, Hideki

AU - Muramatsu, Takashi

AU - Harada, Masahide

AU - Yamada, Akira

AU - Motoyama, Sadako

AU - Matsui, Shigeru

AU - Hayashi, Mutsuharu

AU - Sarai, Masayoshi

AU - Watanabe, Eiichi

AU - Izawa, Hideo

AU - Ozaki, Yukio

PY - 2018/8/18

Y1 - 2018/8/18

N2 - Background: The early prediction of acute kidney injury (AKI) can facilitate timely intervention and prevent complications. We aimed to understand the predictive value of urinary liver-type fatty-acid binding protein (L-FABP) levels on admission to medical (non-surgical) cardiac intensive care units (CICUs) for AKI, both independently and in combination with serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Methods: We prospectively investigated the predictive value of L-FABP and NT-proBNP for AKI in a large, heterogeneous cohort of patients treated in medical CICUs. Baseline urinary L-FABP and serum NT-proBNP were measured on admission. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. We studied 1273 patients (mean age, 68years), among whom 46% had acute coronary syndromes, 38% had acute decompensated heart failure, 5% had arrhythmia, 3% had pulmonary hypertension, 2% had acute aortic syndrome, 2% had infective endocarditis, and 1% had Takotsubo cardiomyopathy. Results: Urinary L-FABP levels correlated with serum NT-proBNP levels (r=0.17, p<0.0001). AKI occurred in 224 patients (17.6%), including 48 patients with stage 2 or 3 disease. Patients who developed AKI had higher one-week and 6-month mortality than those who did not develop AKI (p=0.0002 and p=0.003, respectively). In the multivariate logistic analysis, both L-FABP (p<0.0001) and NT-proBNP (p=0.006) were independently associated with the development of AKI. Adding L-FABP and NT-proBNP to a baseline model that included established risk factors further improved reclassification (p<0.001) and discrimination (p<0.01) beyond that of the baseline model or any single biomarker individually. Conclusions: Urinary L-FABP and serum NT-proBNP levels on admission are independent predictors of AKI, and when used in combination, improve early prediction of AKI in patients hospitalized at medical CICUs.

AB - Background: The early prediction of acute kidney injury (AKI) can facilitate timely intervention and prevent complications. We aimed to understand the predictive value of urinary liver-type fatty-acid binding protein (L-FABP) levels on admission to medical (non-surgical) cardiac intensive care units (CICUs) for AKI, both independently and in combination with serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Methods: We prospectively investigated the predictive value of L-FABP and NT-proBNP for AKI in a large, heterogeneous cohort of patients treated in medical CICUs. Baseline urinary L-FABP and serum NT-proBNP were measured on admission. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. We studied 1273 patients (mean age, 68years), among whom 46% had acute coronary syndromes, 38% had acute decompensated heart failure, 5% had arrhythmia, 3% had pulmonary hypertension, 2% had acute aortic syndrome, 2% had infective endocarditis, and 1% had Takotsubo cardiomyopathy. Results: Urinary L-FABP levels correlated with serum NT-proBNP levels (r=0.17, p<0.0001). AKI occurred in 224 patients (17.6%), including 48 patients with stage 2 or 3 disease. Patients who developed AKI had higher one-week and 6-month mortality than those who did not develop AKI (p=0.0002 and p=0.003, respectively). In the multivariate logistic analysis, both L-FABP (p<0.0001) and NT-proBNP (p=0.006) were independently associated with the development of AKI. Adding L-FABP and NT-proBNP to a baseline model that included established risk factors further improved reclassification (p<0.001) and discrimination (p<0.01) beyond that of the baseline model or any single biomarker individually. Conclusions: Urinary L-FABP and serum NT-proBNP levels on admission are independent predictors of AKI, and when used in combination, improve early prediction of AKI in patients hospitalized at medical CICUs.

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