title: Urinary biomarkers of AKI and mortality 3 years after cardiac surgery.
abstract: Urinary biomarkers of AKI provide prognostic value for in-hospital outcomes, but little is known about their association with longer-term mortality after surgery. We sought to assess the association between kidney injury biomarkers and all-cause mortality in an international, multicenter, prospective long-term follow-up study from six clinical centers in the United States and Canada composed of 1199 adults who underwent cardiac surgery between 2007 and 2009 and were enrolled in the Translational Research in Biomarker Endpoints in AKI cohort. On postoperative days 1-3, we measured the following five urinary biomarkers: neutrophil gelatinase-associated lipocalin, IL-18, kidney injury molecule-1 (KIM-1), liver fatty acid binding protein, and albumin. During a median follow-up of 3.0 years (interquartile range, 2.2-3.6 years), 139 participants died (55 deaths per 1000 person-years). Among patients with clinical AKI, the highest tertiles of peak urinary neutrophil gelatinase-associated lipocalin, IL-18, KIM-1, liver fatty acid binding protein, and albumin associated independently with a 2.0- to 3.2-fold increased risk for mortality compared with the lowest tertiles. In patients without clinical AKI, the highest tertiles of peak IL-18 and KIM-1 also associated independently with long-term mortality (adjusted hazard ratios [95% confidence intervals] of 1.2 [1.0 to 1.5] and 1.8 [1.4 to 2.3] for IL-18 and KIM-1, respectively), and yielded continuous net reclassification improvements of 0.26 and 0.37, respectively, for the prediction of 3-year mortality. In conclusion, urinary biomarkers of kidney injury, particularly IL-18 and KIM-1, in the immediate postoperative period provide additional prognostic information for 3-year mortality risk in patients with and without clinical AKI.
authors.affiliation: Section of Nephrology, Yale University School of Medicine, Program of Applied Translational Research, Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut;
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.affiliation: Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois;
authors.forename: Jay L
authors.initials: JL
authors.lastname: Koyner
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina;
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; and.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: Section of Nephrology, Yale University School of Medicine, Program of Applied Translational Research, Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut; chirag.parikh@yale.edu.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000652:urine*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000652:urine*; D002170:Canada / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D003404:Creatinine