Serum heart-type fatty acid-binding protein level can be used to detect acute kidney injury on admission and predict an adverse outcome in patients with acute heart failure.
BACKGROUND
Different mechanisms of acute kidney injury (AKI) may exist for acute heart failure (AHF) patients compared with other patients.


RESULTS
We analyzed data from 282 patients with AHF. The biomarkers were measured within 30 min of admission. Patients were assigned to a no-AKI (n=213) or AKI group (Class R (n=49), Class I (n=15) or Class F (n=5)) using the RIFLE classifications on admission. We evaluated the relationships between the biomarkers and AKI, in-hospital mortality, all-cause death and HF events (HF re-admission, all-cause death) within 90 days. The serum heart-type fatty acid-binding protein (s-HFABP) levels were significantly higher in the AKI than in the no-AKI group, and the predictive biomarker for AKI was s-HFABP (odds ratio: 6.709; 95% confidence interval: 3.362-13.391). s-HFABP demonstrated an optimal balance between sensitivity and specificity (71.0%, 79.3%; area under the receiver-operating characteristic curve [AUC]=0.790) at 22.8 ng/ml for AKI, at 22.8 ng/ml for Class I/F (90.0%, 71.4%; AUC=0.836) and at 21.0 ng/ml for in-hospital mortality (74.3%, 70.0%; AUC=0.726). The Kaplan-Meier survival curves showed a significantly poorer prognosis in the high s-HFABP group (≥22.9 ng/ml) than in other groups.


CONCLUSIONS
The s-HFABP level can indicate AKI on admission, and a high s-HFABP level is associated with a poorer prognosis for AHF patients.
Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School.
Akihiro
A
Shirakabe
Noritake
N
Hata
Nobuaki
N
Kobayashi
Hirotake
H
Okazaki
Takuro
T
Shinada
Kazunori
K
Tomita
Masanori
M
Yamamoto
Masafumi
M
Tsurumi
Masato
M
Matsushita
Yoshiya
Y
Yamamoto
Shinya
S
Yokoyama
Kuniya
K
Asai
Wataru
W
Shimizu
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D000818:Animals; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002423:Cause of Death; D004285:Dogs; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood* / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000652:urine; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D007902:Length of Stay; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D011518:Proto-Oncogene Proteins / Q000652:urine; D012372:ROC Curve
D000209:Acute-Phase Proteins; D015415:Biomarkers; C493319:FABP1 protein, human; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D010446:Peptide Fragments; D011518:Proto-Oncogene Proteins; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain