title: Spot urine albumin to creatinine ratio outperforms novel acute kidney injury biomarkers in patients with acute myocardial infarction.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a frequent complication in patients hospitalized for acute myocardial infarction (AMI), and is associated with in-hospital and long-term morbidity and mortality. We prospectively assessed the diagnostic performance of spot urine albumin to creatinine ratio (uACR) in an adequately sized multicenter cohort of patients admitted to hospital with AMI. We further compared uACR to novel renal injury associated biomarkers regarding their diagnostic ability.
  
  
  METHODS
  We enrolled 805 consecutive patients presenting with acute ST-elevation and non-ST elevation AMI. Patients were assessed for presence of AKI at 48h post-admission and at hospital discharge using the Acute Kidney Injury Network (AKIN), the Acute Dialysis Quality Initiative [Risk, Injury and Failure (RIFLE)] criteria and the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Blood and urine sampling for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), cystatin-C, and uACR assessment was performed during admission.
  
  
  RESULTS
  The predictive accuracy of uACR was good (Area Under the Curve (AUC), 0.725; 95% CI 0.676-0.774) and was better compared to urine NGAL (P=0.007), urine (P<0.001) and plasma Cystatin-C (P=0.001). ROC analysis identified concentrations of ≥66.7μg/mg as having the best diagnostic accuracy. The use of uACR exhibited good discriminating ability independent to possible cofounders and additive regarding the use of novel biomarkers.
  
  
  CONCLUSIONS
  The use of uACR can easily be applied in the clinical setting, allows for robust risk assessment and offers the potential to improve the management of AMI patients at risk for acute kidney injury.
authors.affiliation: Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. Electronic address: dtziakas@med.duth.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tziakas
authors.affiliation: Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Chalikias
authors.affiliation: Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Kareli
authors.affiliation: Microbiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Tsigalou
authors.affiliation: Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Ali
authors.initials: A
authors.lastname: Risgits
authors.affiliation: Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Kikas
authors.affiliation: Cardiology Department, General Hospital of Kavala, Kavala, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Makrygiannis
authors.affiliation: Second Department of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Chatzikyriakou
authors.affiliation: Microbiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kampouromiti
authors.affiliation: Cardiology Department, General Hospital of Kavala, Kavala, Greece.
authors.forename: David
authors.initials: D
authors.lastname: Symeonidis
authors.affiliation: Second Department of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Voudris
authors.affiliation: Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000209:Acute-Phase Proteins / Q000652:urine; D000419:Albuminuria / Q000652:urine*; D015415:Biomarkers / Q000652:urine*; D003404:Creatinine / Q000652:urine*; D055316:Cystatin C / Q000097:blood / Q000652:urine; D004797:Enzyme-Linked Immunosorbent Assay; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D020382:Interleukin-18 / Q000097:blood / Q000652:urine; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine
keywords: Acute kidney injury; Biomarkers; Diagnosis; Myocardial infarction; Spot urine albumin to creatinine ratio