Abstract 16798: Urinary Biomarkers at Admission in Out-of-hospital Cardiac Arrest Patients May Predict Acute Kidney Injury and Patient Outcome
Introduction: Urine biomarkers may be used to diagnose acute kidney injury (AKI) and predict patient outcome.
Hypothesis: Urinary AKI biomarkers sampled at admission after out-of-hospital cardiac arrest (OHCA) may predict AKI, mortality and unfavourable neurological outcome (UNO).
Methods: Prospective observational study of resuscitated, comatose OHCA patients treated with targeted temperature management to 33°C for 24 hours at Oslo University Hospital Ullevål, Oslo, Norway. AKI was diagnosed during the first three days based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. UNO defined as cerebral performance category 3-5 and mortality were assessed after six months. Urine samples were collected at hospital admission and analyzed for cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and the NephroCheck™ test calculating the product of tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP-7). Data are compared using the Mann-Whitney U test and presented as median (interquartile range) unless otherwise noted.
Results: Among 195 included patients mean age was 60 (± 14 standard deviation) years and 165 (85 %) were males. OHCA was witnessed in 169 (87 %), 128 (66 %) had initial shockable rhythm, and time to ROSC was 25 (16-33) minutes. AKI occurred in 88 (45 %) patients, mortality was 88 (45 %) and 96 (49 %) had UNO. Patients with and without AKI had different levels of cystatin C (639 versus (vs.) 160 ng/mL, p<0.01), NGAL (439 vs.106 ng/mL, p<0.01) and NephroCheck™ (0.65 vs. 0.25, p<0.01), respectively. Non-survivors compared to survivors had higher levels of cystatin C (639 vs. 160 ng/mL, p<0.01), NGAL (506 vs. 91 ng/mL, p<0.01) and NephroCheck™ (0.45 vs. 0.28, p=0.02), respectively. Patients with and without UNO had different levels of cystatin C (612 vs. 166 ng/mL, p<0.01), NGAL (497 vs. 91 ng/mL, p<0.01) and NephroCheck™ (0.43 vs. 0.25, p=0.02), respectively.
Conclusions: In resuscitated, comatose OHCA patients urinary cystatin C, NGAL and NephroCheck™ at admission were significantly different in patients with and without AKI, and also in survivors compared to non-survivors.
Author Disclosures: S. Beitland: None. B. Waldum-Grevbo: None. E.R. Nakstad: None. J. Berg: None. A.S. Trøseid: None. B.S. Brusletto: None. C. Brunborg: None. G.Ø. Andersen: None. K. Sunde: Honoraria; Modest; Received support for lectures and travel from Bard Medical..
- © 2016 by American Heart Association, Inc.