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      Clinical significance of urinary L-FABP in the emergency department

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          Abstract

          Background

          This study’s aim is to measure liver-type fatty acid-binding protein (L-FABP) levels in urine using a rapid semiquantitative assay kit in the emergency department and to investigate whether the onset of acute kidney injury (AKI) after hospitalization can be predicted.

          Methods

          This was a prospective observation study. Patients transferred to the emergency and critical care center were divided into two groups: urinary L-FABP negative and positive groups. The status and severity of AKI were evaluated for the respective patients based on the Kidney Disease: Improving Global Outcome (KDIGO) classification. We compared the proportion of AKI patients in the two groups.

          Results

          In the urine L-FABP-positive group, many patients had a significant onset of AKI ( p < 0.001). After excluding patients who were diagnosed as AKI for creatinine level at admission, urinary L-FABP could predict the onset of AKI after admission ( p < 0.001).

          Conclusion

          By measuring urinary L-FABP concentration using a rapid semiquantitative assay kit, there is the possibility that the onset of AKI after admission can be predicted from immediately after a patient is transported by ambulance.

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          Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children.

          Rajit Basu, Michael Zappitelli, Lori Brunner … (2014)
          Reliable prediction of severe acute kidney injury (AKI) has the potential to optimize treatment. Here we operationalized the empiric concept of renal angina with a renal angina index (RAI) and determined the predictive performance of RAI. This was assessed on admission to the pediatric intensive care unit, for subsequent severe AKI (over 200% rise in serum creatinine) 72 h later (Day-3 AKI). In a multicenter four cohort appraisal (one derivation and three validation), incidence rates for a Day 0 RAI of 8 or more were 15-68% and Day-3 AKI was 13-21%. In all cohorts, Day-3 AKI rates were higher in patients with an RAI of 8 or more with the area under the curve of RAI for predicting Day-3 AKI of 0.74-0.81. An RAI under 8 had high negative predictive values (92-99%) for Day-3 AKI. RAI outperformed traditional markers of pediatric severity of illness (Pediatric Risk of Mortality-II) and AKI risk factors alone for prediction of Day-3 AKI. Additionally, the RAI outperformed all KDIGO stages for prediction of Day-3 AKI. Thus, we operationalized the renal angina concept by deriving and validating the RAI for prediction of subsequent severe AKI. The RAI provides a clinically feasible and applicable methodology to identify critically ill children at risk of severe AKI lasting beyond functional injury. The RAI may potentially reduce capricious AKI biomarker use by identifying patients in whom further testing would be most beneficial.
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            Transient and Persistent Acute Kidney Injury and the Risk of Hospital Mortality in Critically Ill Patients: Results of a Multicenter Cohort Study.

            Sophie Perinel, François Vincent, Alexandre Lautrette … (2015)
            To assess the prognostic impact of transient and persistent acute kidney injury in critically ill patients.
            Article 0 comments Cited 63 times – based on 0 reviews     Review now
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              Urinary L-type fatty acid-binding protein as a new biomarker of sepsis complicated with acute kidney injury.

              Kent Doi, Eisei Noiri, Rui Maeda-Mamiya … (2010)
              This study is aimed to examine whether urinary L-type fatty acid-binding protein can detect the severity of sepsis with animal sepsis models and septic shock patients complicated with established acute kidney injury. Experimental animal models and a clinical, prospective observational study. University laboratory and tertiary hospital. One hundred fourteen human L-type fatty acid-binding protein transgenic mice and 145 septic shock patients with established acute kidney injury. Animals were challenged by abdominal (cecal ligation and puncture) and pulmonary (intratracheal lipopolysaccharide injection) sepsis models with different severities that were confirmed by survival analysis (n = 24) and bronchoalveolar lavage fluid analysis (n = 38). In animal experiments, significant increases of urinary L-type fatty acid-binding protein levels were induced by sepsis (severe cecal ligation and puncture 399.0 ± 226.8 μg/g creatinine [n = 12], less-severe cecal ligation and puncture 89.1 ± 25.3 [n = 11], sham 13.4 ± 3.4 [n = 10] at 6 hrs, p < .05 vs. sham; 200 μg of lipopolysaccharide 190.6 ± 77.4 μg/g creatinine [n = 6], 50 μg of lipopolysaccharide 145.4 ± 32.6 [n = 8], and saline 29.9 ± 14.9 [n = 5] at 6 hrs, p < .05 vs. saline). Urinary L-type fatty acid-binding protein predicted severity more accurately than blood urea nitrogen, serum creatinine, and urinary N-acetyl-d-glucosaminidase levels. In clinical evaluation, urinary L-type fatty acid-binding protein measured at admission was significantly higher in the nonsurvivors of septic shock with established acute kidney injury than in the survivors (4366 ± 192 μg/g creatinine [n = 68] vs. 483 ± 71 [n = 77], p < .05). Urinary L-type fatty acid-binding protein showed the higher value of area under the receiver operating characteristic curve for mortality compared with Acute Physiology and Chronic Health Evaluation (APACHE) II and Sepsis-related Organ Failure Assessment (SOFA) scores (L-type fatty acid-binding protein 0.994 [0.956-0.999], APACHE II 0.927 [0.873-0.959], and SOFA 0.813 [0.733-0.873], p < .05). Our results suggest that urinary L-type fatty acid-binding protein can be a useful biomarker for sepsis complicated with acute kidney injury for detecting its severity.
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                Author and article information

                Contributors
                Ginga Suzuki: 03-3762-4151 , ginga.suzuki@med.toho-u.ac.jp
                Ryo Ichibayashi: ryou.ichibayashi@med.toho-u.ac.jp
                Saki Yamamoto: saki.yamamoto@med.toho-u.ac.jp
                Yoshimi Nakamichi: yoshimi.nakamichi@med.toho-u.ac.jp
                Masayuki Watanabe: masayuki.watanabe@med.toho-u.ac.jp
                Mitsuru Honda: mhonda@med.toho-u.ac.jp
                Journal
                Journal ID (nlm-ta): Int J Emerg Med
                Journal ID (iso-abbrev): Int J Emerg Med
                Title: International Journal of Emergency Medicine
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 1865-1372
                ISSN (Electronic): 1865-1380
                Publication date (Electronic): 30 August 2019
                Publication date PMC-release: 30 August 2019
                Publication date Collection: 2019
                Volume: 12
                Electronic Location Identifier: 24
                Affiliations
                ISNI 0000 0004 1771 2506, GRID grid.452874.8, Emergency and Critical Care Center, , Toho University Omori Medical Center, ; 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan
                Article
                Publisher ID: 244
                DOI: 10.1186/s12245-019-0244-9
                PMC ID: 6716847
                PubMed ID: 31470789
                SO-VID: 4ae0e3fe-e965-438e-8828-aa531dbc486d
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 24 April 2019
                Date accepted : 20 August 2019
                Categories
                Subject: Original Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: liver-type fatty acid-binding protein,l-fabp,acute kidney injury,aki
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: liver-type fatty acid-binding protein, l-fabp, acute kidney injury, aki

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