title: Urinary chitinase 3-like protein 1 for early diagnosis of acute kidney injury: a prospective cohort study in adult critically ill patients.
abstract: BACKGROUND
  Acute kidney injury (AKI) occurs frequently and adversely affects patient and kidney outcomes, especially when its severity increases from stage 1 to stages 2 or 3. Early interventions may counteract such deterioration, but this requires early detection. Our aim was to evaluate whether the novel renal damage biomarker urinary chitinase 3-like protein 1 (UCHI3L1) can detect AKI stage ≥ 2 more early than serum creatinine and urine output, using the respective Kidney Disease | Improving Global Outcomes (KDIGO) criteria for definition and classification of AKI, and compare this to urinary neutrophil gelatinase-associated lipocalin (UNGAL).
  
  
  METHODS
  This was a translational single-center, prospective cohort study at the 22-bed surgical and 14-bed medical intensive care units (ICU) of Ghent University Hospital. We enrolled 181 severely ill adult patients who did not yet have AKI stage ≥ 2 based on the KDIGO criteria at time of enrollment. The concentration of creatinine (serum, urine) and CHI3L1 (serum, urine) was measured at least daily, and urine output hourly, in the period from enrollment till ICU discharge with a maximum of 7 ICU-days. The concentration of UNGAL was measured at enrollment. The primary endpoint was the development of AKI stage ≥ 2 within 12 h after enrollment.
  
  
  RESULTS
  After enrollment, 21 (12%) patients developed AKI stage ≥ 2 within the next 7 days, with 6 (3%) of them reaching this condition within the first 12 h. The enrollment concentration of UCHI3L1 predicted the occurrence of AKI stage ≥ 2 within the next 12 h with a good AUC-ROC of 0.792 (95% CI: 0.726-0.849). This performance was similar to that of UNGAL (AUC-ROC of 0.748 (95% CI: 0.678-0.810)). Also, the samples collected in the 24-h time frame preceding diagnosis of the 1(st) episode of AKI stage ≥ 2 had a 2.0 times higher (95% CI: 1.3-3.1) estimated marginal mean of UCHI3L1 than controls. We further found that increasing UCHI3L1 concentrations were associated with increasing AKI severity.
  
  
  CONCLUSIONS
  In this pilot study we found that UCHI3L1 was a good biomarker for prediction of AKI stage ≥ 2 in adult ICU patients.
authors: Department of Pharmacology, Toxicology and Biochemistry, Laboratory of Biochemistry, Ghent University, Faculty of Veterinary Medicine, Salisburylaan 133, B-9820, Merelbeke, Belgium. Jorien.DeLoor@UGent.be.
authors: Jorien
authors: J
authors: De Loor
authors: Department of Internal Medicine, Division of Intensive Care, Ghent University Hospital, Faculty of Medicine and Health Sciences , De Pintelaan 185, B-9000, Ghent, Belgium. Johan.Decruyenaere@UGent.be.
authors: Johan
authors: J
authors: Decruyenaere
authors: Department of Pharmacology, Toxicology and Biochemistry, Laboratory of Biochemistry, Ghent University, Faculty of Veterinary Medicine, Salisburylaan 133, B-9820, Merelbeke, Belgium. Kristel.Demeyere@UGent.be.
authors: Kristel
authors: K
authors: Demeyere
authors: Bimetra-Clinical Research Center Ghent, Ghent University Hospital, Faculty of Medicine and Health Sciences , De Pintelaan 185, B-9000, Ghent, Belgium. Lieve.Nuytinck@UGent.be.
authors: Lieve
authors: L
authors: Nuytinck
authors: Department of Internal Medicine, Division of Intensive Care, Ghent University Hospital, Faculty of Medicine and Health Sciences , De Pintelaan 185, B-9000, Ghent, Belgium. Eric.Hoste@UGent.be.|Research Foundation-Flanders, Egmontstraat 5, B-1000, Brussels, Belgium. Eric.Hoste@UGent.be.
authors: Eric A J
authors: EA
authors: Hoste
authors: Department of Pharmacology, Toxicology and Biochemistry, Laboratory of Biochemistry, Ghent University, Faculty of Veterinary Medicine, Salisburylaan 133, B-9820, Merelbeke, Belgium. Evelyne.Meyer@UGent.be.
authors: Evelyne
authors: E
authors: Meyer
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis*; D054392:Adipokines / Q000652:urine*; D000368:Aged; D015415:Biomarkers / Q000652:urine*; D000071451:Chitinase-3-Like Protein 1; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D037102:Lectins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D054392:Adipokines; D015415:Biomarkers; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D037102:Lectins