Diagnostic and Prognostic Stratification in the Emergency Department Using Urinary Biomarkers of Nephron Damage A Multicenter Prospective Cohort Study

被引：275

作者：

Nickolas, Thomas L. ^{[1
]}

Schmidt-Ott, Kai M. ^{[1
,2
,3
]}

Canetta, Pietro ^{[1
]}

Forster, Catherine ^{[1
]}

Singer, Eugenia ^{[2
,3
]}

Sise, Meghan ^{[1
]}

Elger, Antje ^{[2
]}

Maarouf, Omar ^{[4
]}

Sola-Del Valle, David Antonio ^{[1
]}

O'Rourke, Matthew ^{[1
]}

Sherman, Evan ^{[1
]}

Lee, Peter ^{[1
]}

Geara, Abdallah ^{[1
]}

Imus, Philip ^{[1
]}

Guddati, Achuta ^{[1
]}

Polland, Allison ^{[1
]}

Rahman, Wasiq ^{[1
]}

Elitok, Saban ^{[3
]}

Malik, Nasir ^{[1
]}

Giglio, James ^{[1
]}

El-Sayegh, Suzanne ^{[4
]}

Devarajan, Prasad ^{[5
]}

Hebbar, Sudarshan ^{[6
]}

Saggi, Subodh J. ^{[4
]}

Hahn, Barry ^{[4
]}

Kettritz, Ralph ^{[2
,3
]}

Luft, Friedrich C. ^{[2
,3
]}

Barasch, Jonathan ^{[1
]}

机构：

[1] Columbia Univ Coll Phys & Surg, New York, NY 10032 USA

[2] Expt & Clin Res Ctr, Berlin, Germany

[3] Helios Clin, Berlin, Germany

[4] Staten Isl Univ Hosp, Staten Isl, NY USA

[5] Cincinnati Childrens Hosp, Cincinnati, OH USA

[6] Abbott Labs, Abbott Pk, IL 60064 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 59卷 / 03期

关键词：

acute kidney injury; biomarkers; outcomes; ACUTE KIDNEY INJURY; GELATINASE-ASSOCIATED LIPOCALIN; ACUTE-RENAL-FAILURE; ACID-BINDING PROTEIN; ADVERSE OUTCOMES; SERUM CREATININE; OLD CONCEPTS; PREDICTS; MORTALITY; DISEASE;

D O I：

10.1016/j.jacc.2011.10.854

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department. Background Intrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI. Methods In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization. Results All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events. Conclusions Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department. (J Am Coll Cardiol 2012;59:246-55) (C) 2012 by the American College of Cardiology Foundation

引用

页码：246 / 255

页数：10

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