title: Combined biomarker analysis for risk of acute kidney injury in patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Acute kidney injury (AKI) complicating ST-segment elevation myocardial infarction (STEMI) increases subsequent morbidity and mortality. We combined the biomarkers of heart failure (HF; B-type natriuretic peptide [BNP] and soluble ST2 [sST2]) and renal injury (NGAL [neutrophil gelatinase-associated lipocalin] and cystatin C) in predicting the development of AKI in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
  
  
  RESULTS
  From March 2010 to September 2013, 189 STEMI patients were sequentially enrolled and serum samples were collected at presentation for BNP, sST2, NGAL and cystatin C analysis. 37 patients (19.6%) developed AKI of varying severity within 48 hours of presentation. Univariate analysis showed age, Killip class ≥2, hypertension, white blood cell counts, hemoglobin, estimated glomerular filtration rate, blood urea nitrogen, creatinine, and all the four biomarkers were predictive of AKI. Serum levels of the biomarkers were correlated with risk of AKI and the Acute Kidney Injury Network (AKIN) stage and all significantly discriminated AKI (area under the receiver operating characteristic [ROC] curve: BNP: 0.86, sST2: 0.74, NGAL: 0.75, cystatin C: 0.73; all P < 0.05). Elevation of ≥2 of the biomarkers higher than the cutoff values derived from the ROC analysis improved AKI risk stratification, regardless of the creatine level (creatinine < 1.24 mg/dL: odds ratio [OR] 11.25, 95% confidence interval [CI] 1.63-77.92, P = 0.014; creatinine ≥ 1.24: OR 15.0, 95% CI 1.23-183.6, P = 0.034).
  
  
  CONCLUSIONS
  In this study of STEMI patients undergoing primary PCI, the biomarkers of heart failure (BNP and sST2) and renal injury (NGAL and cystatin C) at presentation were predictive of AKI. High serum levels of the biomarkers were associated with an elevated risk and more advanced stage of AKI. Regardless of the creatinine level, elevation of ≥2 of the biomarkers higher than the cutoff values indicated a further rise in AKI risk. Combined biomarker approach may assist in risk stratification of AKI in patients with STEMI.
authors: Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Ying-Chang
authors: YC
authors: Tung
authors: Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Chih-Hsiang
authors: CH
authors: Chang
authors: Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Yung-Chang
authors: YC
authors: Chen
authors: Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; Healthcare Center, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taipei, Taiwan.
authors: Pao-Hsien
authors: PH
authors: Chu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D000209:Acute-Phase Proteins; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D055316:Cystatin C / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000473:pathology*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011518:Proto-Oncogene Proteins / Q000097:blood; D012372:ROC Curve; D011956:Receptors, Cell Surface / Q000097:blood
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D011956:Receptors, Cell Surface; D020097:Natriuretic Peptide, Brain