Impact of clinical context on acute kidney injury biomarker performances: differences between neutrophil gelatinase-associated lipocalin and L-type fatty acid-binding protein.
Application of acute kidney injury (AKI) biomarkers with consideration of nonrenal conditions and systemic severity has not been sufficiently determined. Herein, urinary neutrophil gelatinase-associated lipocalin (NGAL), L-type fatty acid-binding protein (L-FABP) and nonrenal disorders, including inflammation, hypoperfusion and liver dysfunction, were evaluated in 249 critically ill patients treated at our intensive care unit. Distinct characteristics of NGAL and L-FABP were revealed using principal component analysis: NGAL showed linear correlations with inflammatory markers (white blood cell count and C-reactive protein), whereas L-FABP showed linear correlations with hypoperfusion and hepatic injury markers (lactate, liver transaminases and bilirubin). We thus developed a new algorithm by combining urinary NGAL and L-FABP with stratification by the Acute Physiology and Chronic Health Evaluation score, presence of sepsis and blood lactate levels to improve their AKI predictive performance, which showed a significantly better area under the receiver operating characteristic curve [AUC-ROC 0.940; 95% confidential interval (CI) 0.793-0.985] than that under NGAL alone (AUC-ROC 0.858, 95% CI 0.741-0.927, P = 0.03) or L-FABP alone (AUC-ROC 0.837, 95% CI 0.697-0.920, P = 0.007) and indicated that nonrenal conditions and systemic severity should be considered for improved AKI prediction by NGAL and L-FABP as biomarkers.
Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Toshifumi
T
Asada
Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
Rei
R
Isshiki
Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Naoki
N
Hayase
Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
Maki
M
Sumida
Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Ryota
R
Inokuchi
Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.|Japan Science and Technology Agency/Japan International Cooperation Agency (JST/JICA), Science and Technology Research Partnership for Sustainable Development (SATREPS), Tokyo, Japan.
Eisei
E
Noiri
Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
Masaomi
M
Nangaku
Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Naoki
N
Yahagi
Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
Kent
K
Doi
D058186:Acute Kidney Injury / Q000097:blood* / Q000378:metabolism*; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood* / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D016638:Critical Illness; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D007958:Leukocyte Count / Q000379:methods; D000071068:Lipocalin-2 / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000097:blood / Q000378:metabolism
D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D019344:Lactic Acid; D002097:C-Reactive Protein