Abstract 14109: Efficacy of the Urinary Liver-Fatty Acid-Binding Protein (LFABP) Excretion to Predict the Acute kidney Injury in Patients with Acute Heart Failure; An Evaluation of Acute Kidney Injury on Admission and the Following Five Days
Backgrounds: We already reported that the presence of acute kidney injury (AKI) on admission and it’s worsening during the first 5 days were associated with a poorer long-term prognosis, including any-cause death and heart failure (HF) event during two-years, in patients with acute HF (AHF). However, it is difficult to predict the AKI, especially AKI on admission and a worsening of the presence AKI.
Methods and Results: One hundred twelve patients with AHF admitted to the intensive care unit were prospectively analyzed. Urinary neutrophil gelatinase-associated lipocalin (NGAL), liver-fatty acid-binding protein (LFABP), β2-microglobulin, N acetyl-β-D glucosaminidase, albumin excretion were measured on admission. They were immediately collected within 30 minutes of admission. No AKI occurred in 69 patients (no-AKI) during the first 5 days. The AKI patients were assigned to two groups based on the timing: AKI presenting upon admission (early-AKI; n=26), or AKI that occurred after admission from days 2 to days 5 (late-AKI; n=17). The early-AKI patients were also assigned to two groups: stable RIFLE class (stable early-AKI; n=16), or step-up RIFLE class during the first 5 days (worsening early-AKI; n=10). We evaluated the relationships between the urinary markers and AKI during first five days. U-NGAL and u-LFABP was significantly higher in AKI group (229.1±284.9 ng/ml, 371.9±788.4 ng/ml) than in no-AKI group (129.4±194.7 ng/ml, 195.5±467.9 ng/ml). A value of u-NGAL produced the optimal balance to indicate of AKI between sensitivity and specificity (62.7% and 62.3%; AUC=0.615, p=0.042) at 74.2 ng/ml, and that of u-LFABP produced it between sensitivity and specificity (69.8% and 61.2%; AUC=0.634, p=0.018) at 56.5 ng/ml. The results of the multivariate logistic regression model for indicating AKI found that the specific urinary biomarker was u-LFABP (> 56.5 ng/ml) (OR: 3.712; 95% CI: 1.555-8.849, p=0.003), and the results for indicating early-AKI and worsening early-AKI found that it was also u-FABP (OR: 5.033; 95% CI: 1.637-15.472, p=0.005, and OR: 8.558; 95% CI: 1.027-71.300, p=0.047).
Conclusions: The urinary LFABP excretion was effective to predict the AKI, especially the early AKI and a worsening of the early AKI during first 5 days, in patients with AHF.
- © 2012 by American Heart Association, Inc.