title: Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery.
abstract: Biomarkers for acute kidney injury (AKI) have been used to predict the progression of AKI, but a systematic comparison of the prognostic ability of each biomarker alone or in combination has not been performed. In order to assess this, we measured the concentration of 32 candidate biomarkers in the urine of 95 patients with AKIN stage 1 after cardiac surgery. Urine markers were divided into eight groups based on the putative pathophysiological mechanism they reflect. We then compared the ability of the markers alone or in combination to predict the primary outcome of worsening AKI or death (23 patients) and the secondary outcome of AKIN stage 3 or death (13 patients). IL-18 was the best predictor of both outcomes (AUC of 0.74 and 0.89). L-FABP (AUC of 0.67 and 0.85), NGAL (AUC of 0.72 and 0.83), and KIM-1 (AUC of 0.73 and 0.81) were also good predictors. Correlation between most of the markers was generally related to their predictive ability, but KIM-1 had a relatively weak correlation with other markers. The combination of IL-18 and KIM-1 had a very good predictive value with an AUC of 0.93 to predict AKIN 3 or death. Thus, a combination of IL-18 and KIM-1 would result in improved identification of high-risk patients for enrollment in clinical trials.
authors.affiliation: 1] Medical Service, Ralph H Johnson VA Medical Center, Charleston, South Carolina, USA [2] Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Arthur
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Hill
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Alge
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Evelyn C
authors.initials: EC
authors.lastname: Lewis
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Neely
authors.affiliation: 1] Medical Service, Ralph H Johnson VA Medical Center, Charleston, South Carolina, USA [2] Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Janech
authors.affiliation: Department of Medicine, University of Tennessee, Chattanooga, Tennessee, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Tumlin
authors.affiliation: Departments of Medicine and Anesthesiology and Critical Care Medicine, George Washington University, Washington, District of Columbia, USA.
authors.forename: Lakhmir S
authors.initials: LS
authors.lastname: Chawla
authors.affiliation: 1] Department of Anesthesiology, Durham VA Medical Center, Durham, North Carolina, USA [2] Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shaw
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000652:urine*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D020382:Interleukin-18 / Q000652:urine*; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D011991:Receptors, Virus; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D016482:Urinalysis
chemical_list: D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D020382:Interleukin-18; D008562:Membrane Glycoproteins; D011991:Receptors, Virus