title: Combination of Urinary Biomarkers Improves Early Detection of Acute Kidney Injury in Patients With Heart Failure.
abstract: BACKGROUND
  Acute kidney injury (AKI) is associated with morality and repeated hospitalization, and is frequently encountered in patients with acute decompensated heart failure (ADHF). However, few effective tools exist for early AKI identification and risk stratification.
  
  
  RESULTS
  This was a prospective observational study conducted in the coronary care unit (CCU) of a tertiary care university hospital. Patients with a diagnosis of ADHF and who were using diuretics were enrolled.Samples collected between December 2013 and February 2015 were tested for serum cystatin C (Cys-C), urinary neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 (KIM-1). Demographic, clinical, and laboratory data were evaluated. A total of 103 adult patients with a mean age of 68 years were investigated. AKI was diagnosed in 49 patients (47.6%). For predicting intrinsic AKI on the first day of CCU admission, a combination of Cys-C and urine KIM-1 yielded an excellent area under the receiver operating characteristic curve of 0.828, a sensitivity of 71.0%, and specificity of 43.0%, for an overall accuracy of 78%.
  
  
  CONCLUSIONS
  In this study, we found that combinations of the biomarker (Cys-C and KIM-1) were an effective clinical model for predicting AKI in patients with ADHF. The biomarker was also useful for differentiating subclinical AKI in patients with ADHF.
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Yang
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.forename: Tien-Hsing
authors.initials: TH
authors.lastname: Chen
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Fan
authors.forename: Su-Wei
authors.initials: SW
authors.lastname: Chang
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Chen
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Chen
authors.forename: Huang-Yu
authors.initials: HY
authors.lastname: Yang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000401:mortality / Q000652:urine; D000072596:Hepatitis A Virus Cellular Receptor 1 / Q000378:metabolism*; D006801:Humans; D008297:Male
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1