Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: A multicenter prospective cohort study

Thomas L. Nickolas, Kai M. Schmidt-Ott, Pietro Canetta, Catherine Forster, Eugenia Singer, Meghan Sise, Antje Elger, Omar Maarouf, David Antonio Sola-Del Valle, Matthew O'Rourke, Evan Sherman, Peter Lee, Abdallah Geara, Philip Imus, Achuta Kumar Guddati, Allison Polland, Wasiq Rahman, Saban Elitok, Nasir Malik, James GiglioSuzanne El-Sayegh, Prasad Devarajan, Sudarshan Hebbar, Subodh J. Saggi, Barry Hahn, Ralph Kettritz, Friedrich C. Luft, Jonathan Barasch

Research output: Contribution to journalArticle

207 Scopus citations

Abstract

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. 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. In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinaseassociated 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. All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinaseassociated 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 gelatinaseassociated 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. Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.

Original languageEnglish (US)
Pages (from-to)246-255
Number of pages10
JournalJournal of the American College of Cardiology
Volume59
Issue number3
DOIs
StatePublished - Jan 17 2012
Externally publishedYes

Keywords

  • acute kidney injury
  • biomarkers
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Nickolas, T. L., Schmidt-Ott, K. M., Canetta, P., Forster, C., Singer, E., Sise, M., Elger, A., Maarouf, O., Sola-Del Valle, D. A., O'Rourke, M., Sherman, E., Lee, P., Geara, A., Imus, P., Guddati, A. K., Polland, A., Rahman, W., Elitok, S., Malik, N., ... Barasch, J. (2012). Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: A multicenter prospective cohort study. Journal of the American College of Cardiology, 59(3), 246-255. https://doi.org/10.1016/j.jacc.2011.10.854