1. Trajectory pattern of serially measured acute kidney injury biomarkers in critically ill patients: a prospective observational study
- Author
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Ryohei Horie, Naoki Hayase, Toshifumi Asada, Miyuki Yamamoto, Takehiro Matsubara, and Kent Doi
- Subjects
Acute kidney injury ,Biomarker ,Trajectory ,Neutrophil gelatinase-associated lipocalin ,Liver-type fatty acid-binding protein ,Major adverse kidney event ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The clinical value of the trajectory of temporal changes in acute kidney injury (AKI) biomarkers has not been well established among intensive care unit (ICU) patients. Methods This is a single-center, prospective observational study, performed at a mixed ICU in a teaching medical institute in Tokyo, Japan. Adult ICU patients with an arterial line and urethral catheter were enrolled from September 2014 to March 2015. Patients who stayed in the ICU for less than 48 h and patients with known end-stage renal disease were excluded from the study. Blood and urine samples were collected for measurement of AKI biomarkers at 0, 12, 24, and 48 h after ICU admission. The primary outcome was major adverse kidney events (MAKE) at discharge, defined as a composite of death, dialysis dependency, and persistent loss of kidney function (≥ 25% decline in eGFR). Results The study included 156 patients. Serum creatinine-based estimated glomerular filtration rate (eGFR), plasma neutrophil gelatinase-associated lipocalin (NGAL), and urinary liver-type fatty acid-binding protein (uL-FABP) were serially measured and each variable was classified into three groups based on group-based trajectory modeling analysis. While the trajectory curves moved parallel to each other (i.e., “low,” “middle,” and “high”) for eGFR and plasma NGAL, the uL-FABP curves showed distinct trajectory patterns and moved in different directions (“low and constant,” “high and exponential decrease,” and “high and exponential increase”). These trajectory patterns were significantly associated with MAKE. MAKE occurred in 16 (18%), 16 (40%), and 9 (100%) patients in the “low and constant,” “high and exponential decrease,” and “high and exponential increase” groups, respectively, based on uL-FABP levels (p-value
- Published
- 2024
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