title: Cardiac biomarkers are associated with maximum stage of acute kidney injury in critically ill patients: a prospective analysis.
abstract: This study aimed to investigate whether cardiac troponin T (cTnT), cardiac troponin I (cTnI) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with acute kidney injury (AKI) and need for acute renal replacement therapy (RRT) in adult patients admitted to the intensive care unit (ICU).
  
  
  
  We analysed prospectively collected data for patients admitted to the ICU between June and December 2010 for non-cardiac reasons. The Kidney Disease Improving Global Outcomes creatinine criteria were applied to identify patients with AKI including those who received acute RRT. Severity of illness was determined by the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Serial Organ Failure Assessment (SOFA) score. Regression analyses were performed to assess the association between cTnT, cTnI and NT-proBNP concentrations on the first day of ICU stay, maximum AKI stages and need for acute RRT. Sensitivity analysis was performed in which patients who developed a myocardial infarction during their stay in the ICU were excluded.
  
  
  
  Of 138 patients included, 73 (53%) had AKI and 40 (29%) required acute RRT. Patients with AKI were significantly older, more likely to have sepsis and had higher APACHE II and SOFA scores on admission to the ICU. In univariable analysis, cTnT, cTnI and NT-proBNP were significantly higher in those with AKI requiring acute RRT, but after adjustment for baseline differences in severity of illness, cumulative fluid balance and pre-existing comorbidities, only NT-proBNP remained significantly associated with worst stage of AKI and need for RRT. cTnT and cTnI were independently associated with the odds of any AKI but not with need for RRT. In a sensitivity analysis in which patients who had an acute myocardial infarction while in the ICU were excluded, NT-proBNP remained independently associated with AKI and acute RRT.
  
  
  
  In critically ill patients admitted to the ICU for non-cardiac reasons, admission NT-proBNP had the strongest independent association with maximum stage of AKI and need for RRT.
authors.affiliation: Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK.
authors.forename: Ryan
authors.initials: R
authors.lastname: Haines
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crichton
authors.affiliation: Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK.
authors.forename: David
authors.initials: D
authors.lastname: Treacher
authors.affiliation: Department of Critical Care, King's College London, Guy's and St Thomas' Foundation Hospital, London, SE1 7EH, UK. Marlies.Ostermann@gstt.nhs.uk.
authors.forename: Marlies
authors.identifier: 0000-0001-9500-9080
authors.initials: M
authors.lastname: Ostermann
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000032:analysis* / Q000097:blood; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D011498:Protein Precursors / Q000032:analysis* / Q000097:blood; D013222:State Medicine / Q000706:statistics & numerical data; D020107:Troponin T / Q000032:analysis* / Q000097:blood; D006113:United Kingdom
chemical_list: D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D020107:Troponin T; D009320:Atrial Natriuretic Factor
keywords: Acute kidney injury; Biomarker; Brain natriuretic peptide; Renal replacement therapy; Troponin