Abstract 13454: Efficacy of the Urinary Hear-Type Fatty Acid-Binding Protein (HFABP) Excretion to Predict the Acute kidney Injury in Patients With Acute Heart Failure; An Evaluation of Acute Kidney Injury Following Five Days
Backgrounds: We reported the presence of acute kidney injury (AKI) on admission and it’s worsening during the first 5 days were associated with a poor prognosis for acute heart failure (AHF). However, it is difficult to predict the AKI, especially a worsening of the presence AKI.
Methods: One hundred seven patients with AHF admitted to the intensive care unit were prospectively analyzed. Urinary heart-type fatty acid-binding protein (u-HFABP), neutrophil gelatinase-associated lipocalin (u-NGAL), liver-fatty acid-binding protein (u-LFABP), β2-microglobulin (u-β2MG), N acetyl-β-D glucosaminidase (u-NAG), u-albumin excretion were measured. They were immediately collected within 30 minutes of admission (Day 1), on Day 4 and Day 14. No AKI occurred in 64 patients 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 during first 5 days (late-AKI; n=17). The early-AKI patients were also assigned: stable RIFLE class (stable early-AKI; n=17), or step-up RIFLE class during the first 5 days (worsening early-AKI; n=9). We evaluated the relationships between the urinary markers and AKI during first five days.
Results: U-HFABP, NGAL, LFABP, β2MG, NAG and albumin excretion were above the normal ranges in patients with AHF on Day 1. Only U-HFABP was significantly higher in AKI group (87.6 [21.6 to 202.0] ng/ml) than in no-AKI group (38.8 [14.2 to 104.3] ng/ml, p=0.030). U-HFABP significantly decreased on Day 4 and Day 14 (4.1 [2.0 to 25.9] ng/ml and 4.0 [2.0 to 11.1]; p<0.001) in comparison to the value on Day 1 (57.6 [15.8 to 138.5] ng/ml). A value of u-HFABP produced the optimal balance to indicate of AKI between sensitivity and specificity (69.0% and 65.4%; AUC=0.625, p=0.030) at 40.5 ng/ml, and it was significantly (p<0.001) correlated with u-NGAL (r=0.462), u-LFABP (r=0.422) and s-HFABP (r=0.506). U-HFABP was significantly higher in worsening early-AKI group (153 [136 to 358] ng/ml) than in the other group (44.2 [13.7 to 117.3] ng/ml, p=0.029).
Conclusions: The urinary HFABP excretion was effective to predict the AKI, especially a worsening of the early AKI during first 5 days. The urinary HFABP might reflect the renal tubular injury and the myocardial damage for AHF.
- © 2013 by American Heart Association, Inc.