title: Acute kidney injury biomarkers for patients in a coronary care unit: a prospective cohort study.
abstract: BACKGROUND
  Renal dysfunction is an established predictor of all-cause mortality in intensive care units. This study analyzed the outcomes of coronary care unit (CCU) patients and evaluated several biomarkers of acute kidney injury (AKI), including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18) and cystatin C (CysC) on the first day of CCU admission.
  
  
  RESULTS
  Serum and urinary samples collected from 150 patients in the coronary care unit of a tertiary care university hospital between September 2009 and August 2010 were tested for NGAL, IL-18 and CysC. Prospective demographic, clinical and laboratory data were evaluated as predictors of survival in this patient group. The most common cause of CCU admission was acute myocardial infarction (80%). According to Acute Kidney Injury Network criteria, 28.7% (43/150) of CCU patients had AKI of varying severity. Cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.05) between patients with AKI versus those without AKI. For predicting AKI, serum CysC displayed an excellent areas under the receiver operating characteristic curve (AUROC) (0.895 ± 0.031, p < 0.001). The overall 180-day survival rate was 88.7% (133/150). Multiple Cox logistic regression hazard analysis revealed that urinary NGAL, serum IL-18, Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) and sodium on CCU admission day one were independent risk factors for 6-month mortality. In terms of 6-month mortality, urinary NGAL had the best discriminatory power, the best Youden index, and the highest overall correctness of prediction.
  
  
  CONCLUSIONS
  Our data showed that serum CysC has the best discriminative power for predicting AKI in CCU patients. However, urinary NGAL and serum IL-18 are associated with short-term mortality in these critically ill patients.
authors.affiliation: Second Section of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Tien-Hsing
authors.initials: TH
authors.lastname: Chen
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.forename: Chan-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Jenq
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Chang
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.forename: Ming-Shien
authors.initials: MS
authors.lastname: Wen
authors.forename: Fun-Chung
authors.initials: FC
authors.lastname: Lin
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000150:complications / Q000378:metabolism* / Q000401:mortality*; D000209:Acute-Phase Proteins / Q000378:metabolism; D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D002309:Cardiology / Q000379:methods; D002318:Cardiovascular Diseases / Q000150:complications / Q000378:metabolism / Q000401:mortality*; D003325:Coronary Care Units; D003404:Creatinine / Q000378:metabolism; D055316:Cystatin C / Q000378:metabolism; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000378:metabolism; D000071068:Lipocalin-2; D054834:Lipocalins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine