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      The Level of the Biomarkers at the Time of Nephrology Consultation Might Predict the Prognosis of Acute Kidney Injury in Hospitalized Patients

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          Abstract

          Introduction: The value of biomarkers at the time of nephrology consultation in predicting the prognosis of acute kidney injury (AKI) in hospitalized patients has not been well described. This study aimed to evaluate the possibility of biomarkers at the time of nephrology consultation in predicting the prognosis of AKI. Methods: We prospectively enrolled 103 hospitalized patients who developed AKI. Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL), IL-6, IL-18, N-Acetyl-F-D-Glucosaminidase (NAG), and serum Cystatin C (CysC) were measured at the time of nephrology consultation. Baseline values of serum creatinine (bScr), serum creatinine on consultation (cScr) and the peak level of serum creatinine (pScr) were recorded. All the patients were followed-up till 28 days since consultation. Serum and urinary levels of the biomarkers were compared according to the patient or kidney prognosis. Each marker was assessed for its predictive value using receiver operator characteristic (ROC) curves to predict AKI prognosis. Results: Patients were aged 54.28 w 19.05. Male patients constituted 65% of the study group and baseline Scr was 93.54 w 35.98 Vmol/l. The mortality rate of the patients was 25.2% and kidney loss rate was 18.8% at 28 days after consultation. The level of urinary NGAL was significantly higher in death patients than that in survival patients [147.00 (31.59, 221.87) Vg/ml vs. 22.43 (6.48, 89.77) Vg/ml, p = 0.001], while the level of bScr, cScr, pScr, urinary IL-6 and NAG were similar in both these groups. The AUC of urinary NGAL for predicting patients' death was 0.723 (p = 0.001). Serum CysC and urinary IL-18 concentration was higher in the death patients with a marginal p value (p = 0.065 and 0.059 respectively). All the urinary markers, including NAG, NGAL, IL-6 and IL-18 were significantly higher in patients with kidney loss than in those with kidney survival, while no difference was found in Scr and serum CysC levels. The AUCs of these urinary biomarkers for predicting kidney survival were 0.663, 0.655, 0.705 and 0.663 respectively (p < 0.05). The concentrations of cScr, pScr, serum CysC, urinary IL-6 and NGAL were significantly higher in RRT patients (p < 0.05). The AUCs for predicting RRT were 0.628, 0.781, 0.768, 0.672 and 0.775 respectively. Conclusions: The level of biomarkers at the time of nephrology consultation might predict the prognosis of AKI in hospitalized patients. Further studies should be done to understand the role of the serum and urinary markers in the prognosis of AKI. i 2014 S. Karger AG, Basel

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          Most cited references16

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          Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

          The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.
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            Is Open Access

            Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study

            Introduction Acute kidney injury (AKI) is a frequent complication of cardiopulmonary bypass (CPB). The lack of early biomarkers has impaired our ability to intervene in a timely manner. We previously showed in a small cohort of patients that plasma neutrophil gelatinase-associated lipocalin (NGAL), measured using a research enzyme-linked immunosorbent assay, is an early predictive biomarker of AKI after CPB. In this study we tested whether a point-of-care NGAL device can predict AKI after CPB in a larger cohort. Methods First, in a cross-sectional pilot study including 40 plasma samples (NGAL range 60 to 730 ng/ml) and 12 calibration standards (NGAL range 0 to 1,925 ng/ml), NGAL measurements by enzyme-linked immunosorbent assay and by Triage® NGAL Device (Biosite Inc., San Diego, CA, USA) were highly correlated (r = 0.94). Second, in a subsequent prospective uncontrolled cohort study, 120 children undergoing CPB were enrolled. Plasma was collected at baseline and at frequent intervals for 24 hours after CPB, and analyzed for NGAL using the Triage® NGAL device. The primary outcome was AKI, which was defined as a 50% or greater increase in serum creatinine. Results AKI developed in 45 patients (37%), but the diagnosis using serum creatinine was delayed by 2 to 3 days after CPB. In contrast, mean plasma NGAL levels increased threefold within 2 hours of CPB and remained significantly elevated for the duration of the study. By multivariate analysis, plasma NGAL at 2 hours after CPB was the most powerful independent predictor of AKI (β = 0.004, P < 0.0001). For the 2-hour plasma NGAL measurement, the area under the curve was 0.96, sensitivity was 0.84, and specificity was 0.94 for prediction of AKI using a cut-off value of 150 ng/ml. The 2 hour postoperative plasma NGAL levels strongly correlated with change in creatinine (r = 0.46, P < 0.001), duration of AKI (r = 0.57, P < 0.001), and length of hospital stay (r = 0.44, P < 0.001). The 12-hour plasma NGAL strongly correlated with mortality (r = 0.48, P = 0.004) and all measures of morbidity mentioned above. Conclusion Accurate measurements of plasma NGAL are obtained using the point-of-care Triage® NGAL device. Plasma NGAL is an early predictive biomarker of AKI, morbidity, and mortality after pediatric CPB.
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              Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery--a prospective cohort study.

              To compare the value of novel with conventional serum biomarkers in the prediction of acute kidney injury (AKI) in adult cardiac surgical patients according to preoperative renal function. Single-center, prospective observational study. Tertiary hospital. One hundred adult cardiac surgical patients. We measured concentrations of plasma neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C, and creatinine and urea at baseline, on arrival in the intensive care unit (ICU) and at 24 hours postoperatively. We assessed such biomarkers in relation to the development of AKI (>50% increase in creatinine from baseline) and to a composite end point (need for renal replacement therapy and in-hospital mortality). We defined an area under the receiver operating characteristic curve of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. On arrival in ICU, plasma NGAL and serum cystatin C were of good predictive value, but creatinine and urea were of poor predictive value. After exclusion of patients with preoperative renal impairment (estimated glomerular filtration rate <60 mL/min), the predictive performance for AKI of all renal biomarkers on arrival in ICU remained unchanged except for cystatin C, which was of fair value in such patients. At 24 hours postoperatively, all renal biomarkers were of good predictive value. On arrival in ICU, novel biomarkers were superior to conventional biomarkers (p < 0.05). Plasma NGAL (p = 0.015) and serum cystatin C (p = 0.007) were independent predictors of AKI and of excellent value in the prediction of the composite end point. Early postoperative measurement of plasma NGAL was of good value in identifying patients who developed AKI after adult cardiac surgery. Plasma NGAL and serum cystatin C were superior to conventional biomarkers in the prediction of AKI and were also of prognostic value in this setting.
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2014
                December 2014
                17 October 2014
                : 38
                : 2
                : 89-95
                Affiliations
                Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
                Author notes
                *Yucheng Yan, Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127 (China), E-Mail yucheng.yan@163.com
                Article
                362865 Blood Purif 2014;38:89-95
                10.1159/000362865
                25342236
                6f812948-7384-4de0-8699-7f4733f830bb
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 20 February 2014
                : 15 April 2014
                Page count
                Figures: 1, Tables: 4, Pages: 7
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                NGAL,IL-18,IL-6,NAG,Acute kidney injury,Prognosis,Cystatin C
                Cardiovascular Medicine, Nephrology
                NGAL, IL-18, IL-6, NAG, Acute kidney injury, Prognosis, Cystatin C

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