Abstract 14916: Combined Assessment of Urinary Neutrophil Gelatinase-Associated Lipocalin and Albumin to Creatinine Ratio on Admission Improves the Prediction of Acute Kidney Injury in Patients Hospitalized to Coronary Care Units
Background: The early and accurate prediction of acute kidney injury (AKI) by current clinical and laboratory methods remains inadequate. We prospectively investigated the incremental predictive value of a combination of urinary markers such as neutrophil gelatinase-associated lipocalin (NGAL), albumin to creatinine ratio (UAC), and liver-type fatty-acid binding protein (LFABP) for AKI which develops after admission to coronary care units (CCUs).
Methods: We studied 896 consecutive patients (median,74 yrs) who admitted to CCUs. Baseline urinary samples for measurements of NGAL, UAC, and LFABP were obtained on admission. Among these patients, heart failure was present in 52%, and acute coronary syndrome in 41%. AKI was defined as a greater than 25% increase in creatinine from the baseline or an absolute increase of ≥ 0.5 mg/dl within 48h after admission.
Results: NGAL levels significantly (P < 0.0001) correlated with UAC (r = 0.34) and LFABP (r = 0.52) levels. AKI occurred in 126 (14%) patients. Patients with AKI were older (76 vs. 73 yrs, p = 0.006) , had a higher prevalence of heart failure (76 vs. 54 %, p = 0.0004), higher serum levels of NT-proBNP (2585 vs. 1530 pg/ml, p =0.0002) and high-sensitive C-reactive protein (4.0 vs. 2.0 mg/l, p = 0.003), had higher urinary levels of NGAL (76 vs. 19 μg/gCr, p < 0.0001), UAC (127 vs. 46 mg/gCr, p < 0.0001), and LFABP (34 vs. 15 μg/gCr, p < 0.0001), and had lower estimated GFR values compared with those without AKI. Patients with AKI had a higher risk for in-hospital mortality (18 vs. 4%, P < 0.0001) compared with those without AKI. In stepwise multivariate logistic analysis including 13 clinical variables, tertiles of NGAL (P = 0.008) and UAC (P = 0.007), but not LFABP, were independently associated with the development of AKI. The combination of NGAL and UAC tertiles were associated with increased AKI rates (Figure).
Conclusions: The combined assessment of NGAL and UAC on admission can improve the prediction of AKI in patients hospitalized to CCUs.
Author Disclosures: R. Okuyama: None. J. Ishii: None. H. Kawai: None. T. Muramatsu: None. H. Naruse: None. S. Motoyama: None. S. Matsui: None. H. Izawa: None. Y. Ozaki: None.
- © 2014 by American Heart Association, Inc.