title: A pilot study of urinary fibroblast growth factor-2 and epithelial growth factor as potential biomarkers of acute kidney injury in critically ill children.
abstract: BACKGROUND
  Acute kidney injury (AKI) increases the morbidity of critically ill children. Thus, it is necessary to identify better renal biomarkers to follow the outcome of these patients. This prospective case-control study explored the clinical value of a urinary biomarker profile comprised of neutrophil gelatinase lipocalin (uNGAL), fibroblast growth factor-2 (uFGF-2), and epidermal growth factor (uEGF) to follow these patients.
  
  
  METHODS
  Urine samples were collected from 21 healthy children, and 39 critically ill children (mean age 7.5 years ± 6.97 SD) admitted to a pediatric intensive care unit with sepsis or requiring extra corporeal membrane oxygenation (ECMO). uNGAL, uFGF-2, and uEGF levels were measured using ELISA kits during the first 24 h of admission to PICU, at peak of illness, and upon resolution of the critical illness.
  
  
  RESULTS
  On admission, the uNGAL and uFGF-2 levels were increased, and the uEGF levels were decreased, in critically ill children with AKI (n = 19) compared to those without AKI (n = 20), and healthy controls. A biomarker score using the combined cut-off values of uNGAL, uFGF-2, and uEGF (AUC = 0.90) showed the highest specificity to identify children with AKI, relative to each biomarker alone. uNGAL and uFGF-2 on admission showed high sensitivity and specificity to predict mortality (AUC = 0.82).
  
  
  CONCLUSIONS
  The biomarker profile comprised of uNGAL, uFGF-2, and uEGF increased the specificity to detect AKI in critically ill children, when compared to each biomarker used alone. uNGAL and uFGF-2 may also predict the risk of death. Further validation of these findings in a large sample size is warranted.
authors.affiliation: Division of Pediatric Critical Care, Children's National Medical Center, Washington, DC, USA.
authors.forename: Kitman
authors.initials: K
authors.lastname: Wai
authors.forename: Angel A
authors.initials: AA
authors.lastname: Soler-García
authors.forename: Sofia
authors.initials: S
authors.lastname: Perazzo
authors.forename: Parnell
authors.initials: P
authors.lastname: Mattison
authors.forename: Patricio E
authors.initials: PE
authors.lastname: Ray
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000652:urine*; D015415:Biomarkers; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D016638:Critical Illness; D004815:Epidermal Growth Factor / Q000652:urine*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000652:urine*; D018093:Gelatinases / Q000097:blood; D006801:Humans; D007223:Infant; D007902:Length of Stay; D054834:Lipocalins / Q000097:blood; D008297:Male; D009504:Neutrophils / Q000201:enzymology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000150:complications / Q000652:urine; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D054834:Lipocalins; D016222:Fibroblast Growth Factor 2; D004815:Epidermal Growth Factor; D003404:Creatinine; D018093:Gelatinases