title: The potential utility of urinary biomarkers for risk prediction in combat casualties: a prospective observational cohort study.
abstract: BACKGROUND
  Traditional risk scoring prediction models for trauma use either anatomically based estimations of injury or presenting vital signs. Markers of organ dysfunction may provide additional prognostic capability to these models. The objective of this study was to evaluate if urinary biomarkers are associated with poor outcomes, including death and the need for renal replacement therapy.
  
  
  METHODS
  We conducted a prospective, observational study in United States Military personnel with traumatic injury admitted to the intensive care unit at a combat support hospital in Afghanistan.
  
  
  RESULTS
  Eighty nine patients with urine samples drawn at admission to the intensive care unit were studied. Twelve patients subsequently died or needed renal replacement therapy. Median admission levels of urinary cystatin C (CyC), interleukin 18 (IL-18), L-type fatty acid binding protein (LFABP) and neutrophil gelatinase-associated lipocalin (NGAL) were significantly higher in patients that developed the combined outcome of death or need for renal replacement therapy. Median admission levels of kidney injury molecule-1 were not associated with the combined outcome. The area under the receiver operating characteristic curves for the combined outcome were 0.815, 0.682, 0.842 and 0.820 for CyC, IL-18, LFABP and NGAL, respectively. Multivariable regression adjusted for injury severity score, revealed CyC (OR 1.97, 95 % confidence interval 1.26-3.10, p = 0.003), LFABP (OR 1.92, 95 % confidence interval 1.24-2.99, p = 0.004) and NGAL (OR 1.80, 95 % confidence interval 1.21-2.66, p = 0.004) to be significantly associated with the composite outcome.
  
  
  CONCLUSIONS
  Urinary biomarker levels at the time of admission are associated with death or need for renal replacement therapy. Larger multicenter studies will be required to determine how urinary biomarkers can best be used in future prediction models.
authors.affiliation: Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. ian.stewart@us.af.mil.|David Grant Medical Center, 101 Boden Circle, Travis Air Force Base, CA, 94535, USA. ian.stewart@us.af.mil.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Stewart
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam, Houston, TX, 78234-6200, USA. kristen.r.glass.mil@mail.mil.|Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. kristen.r.glass.mil@mail.mil.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Glass
authors.affiliation: United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Ft Sam, Houston, TX, 78234-7767, USA. jeffhoward01@gmail.com.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Howard
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam, Houston, TX, 78234-6200, USA. benjamin.d.morrow4.mil@mail.mil.|Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. benjamin.d.morrow4.mil@mail.mil.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Morrow
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam, Houston, TX, 78234-6200, USA. jonathan.a.sosnov.mil@mail.mil.|Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. jonathan.a.sosnov.mil@mail.mil.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Sosnov
authors.affiliation: Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA. edward.siew@Vanderbilt.Edu.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
authors.affiliation: Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA. nancy.wickersham@Vanderbilt.Edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Wickersham
authors.affiliation: Kessler Medical Center, 301 Fisher St, Keesler AFB, MS, 39534, USA. wayne.latack@us.af.mil.
authors.forename: Wayne
authors.initials: W
authors.lastname: Latack
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam, Houston, TX, 78234-6200, USA. hana.k.kwan.mil@mail.mil.
authors.forename: Hana K
authors.initials: HK
authors.lastname: Kwan
authors.affiliation: Eglin Hospital, 307 Boatner Road, Eglin Air Force Base, FL, 32542, USA. kdheegard@yahoo.com.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Heegard
authors.affiliation: United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Ft Sam, Houston, TX, 78234-7767, USA. christinadiaz@gmail.com.
authors.forename: Christina
authors.initials: C
authors.lastname: Diaz
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam, Houston, TX, 78234-6200, USA. aaron.t.henderson2.mil@mail.mil.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Henderson
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam, Houston, TX, 78234-6200, USA. kristin.k.saenz.mil@mail.mil.
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Saenz
authors.affiliation: Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA. alp.ikizler@Vanderbilt.Edu.
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.affiliation: Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. kevin.k.chung.mil@mail.mil.|United States Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Ft Sam, Houston, TX, 78234-7767, USA. kevin.k.chung.mil@mail.mil.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine*; D000328:Adult; D055826:Afghan Campaign 2001-; D015415:Biomarkers / Q000652:urine; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008889:Military Personnel; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers