title: Performance of kidney injury molecule-1 and liver fatty acid-binding protein and combined biomarkers of AKI after cardiac surgery.
abstract: OBJECTIVE
  AKI is common and novel biomarkers may help provide earlier diagnosis and prognosis of AKI in the postoperative period.
  
  
  METHODS
  This was a prospective, multicenter cohort study involving 1219 adults and 311 children consecutively enrolled at eight academic medical centers. Performance of two urine biomarkers, kidney injury molecule-1 (KIM-1) and liver fatty acid-binding protein (L-FABP), alone or in combination with other injury biomarkers during the perioperative period was evaluated. AKI was defined as doubling of serum creatinine or need for acute dialysis.
  
  
  RESULTS
  KIM-1 peaked 2 days after surgery in adults and 1 day after surgery in children, whereas L-FABP peaked within 6 hours after surgery in both age groups. In multivariable analyses, the highest quintile of the first postoperative KIM-1 level was associated with AKI compared with the lowest quintile in adults, whereas the first postoperative L-FABP was not associated with AKI. Both KIM-1 and L-FABP were not significantly associated with AKI in adults or children after adjusting for other kidney injury biomarkers (neutrophil gelatinase-associated lipocalin and IL-18). The highest area under the curves achievable for discrimination for AKI were 0.78 in adults using urine KIM-1 from 6 to 12 hours, urine IL-18 from day 2, and plasma neutrophil gelatinase-associated lipocalin from day 2 and 0.78 in children using urine IL-18 from 0 to 6 hours and urine L-FABP from day 2.
  
  
  CONCLUSIONS
  Postoperative elevations of KIM-1 associate with AKI and adverse outcmes in adults but were not independent of other AKI biomarkers. A panel of multiple biomarkers provided moderate discrimination for AKI.
authors.affiliation: Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06510, USA. chirag.parikh@yale.edu
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Deepak
authors.initials: D
authors.lastname: Kadiyala
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Jay L
authors.initials: JL
authors.lastname: Koyner
authors.forename: Charles L
authors.initials: CL
authors.lastname: Edelstein
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
authors.forename: Cary S
authors.initials: CS
authors.lastname: Passik
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D042241:Early Diagnosis; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007223:Infant; D020382:Interleukin-18 / Q000652:urine; D016014:Linear Models; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D016015:Logistic Models; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D008875:Middle Aged; D009656:North America; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine; D012372:ROC Curve; D011991:Receptors, Virus; D012307:Risk Factors
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus