title: Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: a multicenter prospective cohort study.
abstract: OBJECTIVE
  This study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department.
  
  
  BACKGROUND
  Intrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI.
  
  
  METHODS
  In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization.
  
  
  RESULTS
  All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events.
  
  
  CONCLUSIONS
  Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Nickolas
authors.forename: Kai M
authors.initials: KM
authors.lastname: Schmidt-Ott
authors.forename: Pietro
authors.initials: P
authors.lastname: Canetta
authors.forename: Catherine
authors.initials: C
authors.lastname: Forster
authors.forename: Eugenia
authors.initials: E
authors.lastname: Singer
authors.forename: Meghan
authors.initials: M
authors.lastname: Sise
authors.forename: Antje
authors.initials: A
authors.lastname: Elger
authors.forename: Omar
authors.initials: O
authors.lastname: Maarouf
authors.forename: David Antonio
authors.initials: DA
authors.lastname: Sola-Del Valle
authors.forename: Matthew
authors.initials: M
authors.lastname: O'Rourke
authors.forename: Evan
authors.initials: E
authors.lastname: Sherman
authors.forename: Peter
authors.initials: P
authors.lastname: Lee
authors.forename: Abdallah
authors.initials: A
authors.lastname: Geara
authors.forename: Philip
authors.initials: P
authors.lastname: Imus
authors.forename: Achuta
authors.initials: A
authors.lastname: Guddati
authors.forename: Allison
authors.initials: A
authors.lastname: Polland
authors.forename: Wasiq
authors.initials: W
authors.lastname: Rahman
authors.forename: Saban
authors.initials: S
authors.lastname: Elitok
authors.forename: Nasir
authors.initials: N
authors.lastname: Malik
authors.forename: James
authors.initials: J
authors.lastname: Giglio
authors.forename: Suzanne
authors.initials: S
authors.lastname: El-Sayegh
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Hebbar
authors.forename: Subodh J
authors.initials: SJ
authors.lastname: Saggi
authors.forename: Barry
authors.initials: B
authors.lastname: Hahn
authors.forename: Ralph
authors.initials: R
authors.lastname: Kettritz
authors.forename: Friedrich C
authors.initials: FC
authors.lastname: Luft
authors.forename: Jonathan
authors.initials: J
authors.lastname: Barasch
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000473:pathology / Q000652:urine*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009399:Nephrons / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers