Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Predictive Performance of Neutrophil Gelatinase Associated Lipocalin, Liver Type Fatty Acid Binding Protein, and Cystatin C for Acute Kidney Injury and Mortality in Severely Ill Patients

  • Ayu Asakage (INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite de Paris Cite) ;
  • Shiro Ishihara (Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Louis Boutin (INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite de Paris Cite) ;
  • Francois Depret (INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite de Paris Cite) ;
  • Takeshi Sugaya (Department of Nephrology and Hypertension, St. Marianna University School of Medicine) ;
  • Naoki Sato (Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital) ;
  • Etienne Gayat (INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite de Paris Cite) ;
  • Alexandre Mebazaa (INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite de Paris Cite) ;
  • Benjamin Deniau (INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite de Paris Cite)
  • Received : 2023.02.25
  • Accepted : 2023.09.07
  • Published : 2024.03.01
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Abstract

Background: Acute kidney injury (AKI) is a common condition in severely ill patients associated with poor outcomes. We assessed the associations between urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary liver-type fatty acid-binding protein (uLFABP), and urinary cystatin C (uCysC) concentrations and patient outcomes. Methods: We assessed the predictive performances of uNGAL, uLFABP, and uCysC measured in the early phase of intensive care unit (ICU) management and at discharge from the ICU in severely ill patients for short- and long-term outcomes. The primary outcome was the occurrence of AKI during ICU stay; secondary outcomes were 28-day and 1-yr allcause mortality. Results: In total, 1,759 patients were admitted to the ICU, and 728 (41.4%) developed AKI. Median (interquartile range, IQR) uNGAL, uLFABP, and uCysC concentrations on admission were 147.6 (39.9-827.7) ng/mL, 32.4 (10.5-96.0) ng/mL, and 0.33 (0.12-2.05) mg/L, respectively. Biomarker concentrations on admission were higher in patients who developed AKI and associated with AKI severity. Three hundred fifty-six (20.3%) and 647 (37.9%) patients had died by 28 days and 1-yr, respectively. Urinary biomarker concentrations at ICU discharge were higher in non-survivors than in survivors. The areas under the ROC curve (95% confidence interval) of uLFABP for the prediction of AKI, 28-day mortality, and 1-yr mortality (0.70 [0.67-0.72], 0.63 [0.59-0.66], and 0.57 [0.51-0.63], respectively) were inferior to those of the other biomarkers. Conclusions: uNGAL, uLFABP, and uCysC concentrations on admission were associated with poor outcomes. However, their predictive performance, individually and in combination, was limited. Further studies are required to confirm our results.

Keywords

Acknowledgement

The authors are grateful to Marie-Celine Fournier who coordinated the organizational aspects of the study. They also thank the Centre de Recherche Clinique (CRC) of Lariboisiere University Hospital for support and the investigators of the FROG-ICU study.

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