Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure: A Prospective, Two-Stage Study.
A major challenge in prevention and early treatment of acute cardiorenal syndrome (CRS) is the lack of high-performance predictors. To test the hypothesis that urinary angiotensinogen (uAGT) is an early predictor for acute CRS and 1-year prognosis in patients with acute decompensated heart failure (ADHF), we performed a prospective, two-stage, multicenter cohort study in patients with ADHF. In stage I (test set), 317 patients were recruited from four centers. In stage II (validation set), 119 patients were enrolled from two other centers. Daily uAGT levels were analyzed consecutively. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines. In stage I, 104 (32.8%) patients developed AKI during hospitalization. Daily uAGT peaked on the first hospital day in patients who subsequently developed AKI. After multivariable adjustment, the highest quartile of uAGT on admission was associated with a 50-fold increased risk of AKI compared with the lowest quartile. For predicting AKI, uAGT (area under the receiver-operating characteristic curve [AUC]=0.84) outperformed urinary neutrophil gelatinase-associated lipocalin (AUC=0.78), the urinary albumin/creatinine ratio (AUC=0.71), and the clinical model (AUC=0.77). Survivors in stage I were followed prospectively for 1 year after hospital discharge. The uAGT level independently predicted the risk of 1-year mortality (adjusted odds ratio, 4.5; 95% confidence interval, 2.1 to 9.5) and rehospitalization (adjusted odds ratio, 3.6; 95% confidence interval, 1.6 to 5.7). The ability of uAGT in predicting AKI was validated in stage II (AUC=0.79). In conclusion, uAGT is a strong predictor for acute CRS and 1-year prognosis in ADHF.
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
Xiaobing
X
Yang
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China;
Chunbo
C
Chen
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
Jianwei
J
Tian
Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China;
Yan
Y
Zha
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
Yuqin
Y
Xiong
Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China;
Zhaolin
Z
Sun
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
Pingyan
P
Chen
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
Jun
J
Li
Futian Hospital, Guangdong Medical College, Shenzhen, China;
Tiecheng
T
Yang
Institute of Nephrology, Guangdong Medical College, Zhanjiang, China; and.
Changsheng
C
Ma
Institute of Nephrology, Guangdong Medical College, Zhanjiang, China; and.
Huafeng
H
Liu
Center on Early Life Origins of Disease, Johns Hopkins University, Baltimore, Maryland ffhouguangzhou@163.com xiwang@jhsph.edu.
Xiaobin
X
Wang
National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; ffhouguangzhou@163.com xiwang@jhsph.edu.
Fan Fan
FF
Hou
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000652:urine; D000368:Aged; D000369:Aged, 80 and over; D000808:Angiotensinogen / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D002681:China / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000652:urine; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies
D015415:Biomarkers; D000808:Angiotensinogen
acute; acute cardiorenal syndrome; decompensated heart failure; prognosis; urinary angiotensinogen