Diagnostic and Prognostic Stratification in the Emergency Department Using Urinary Biomarkers of Nephron Damage A Multicenter Prospective Cohort Study

作者：Nickolas Thomas L; Schmidt Ott Kai M^*; Canetta Pietro; Forster Catherine; Singer Eugenia; Sise Meghan; Elger Antje; Maarouf Omar; Sola Del Valle David Antonio; O'Rourke Matthew; Sherman Evan; Lee Peter; Geara Abdallah; Imus Philip; Guddati Achuta; Polland Allison; Rahman Wasiq; Elitok Saban; Malik Nasir; Giglio James; El Sayegh Suzanne; Devarajan Prasad; Hebbar Sudarshan; Saggi Subodh J; Hahn Barry; Kettritz Ralph; Luft Friedrich C; Barasch Jonathan

来源：Journal of the American College of Cardiology, 2012, 59(3): 246-255.

DOI：10.1016/j.jacc.2011.10.854

• acute kidney injury
• biomarkers
• outcomes

Objectives This study aimed to determine the diagnostic and prognostic value of urinary biomarkers of intrinsic acute kidney injury (AKI) when patients were triaged in the emergency department.
Background Intrinsic AKI is associated with nephron injury and results in poor clinical outcomes. Several urinary biomarkers have been proposed to detect and measure intrinsic AKI.
Methods In a multicenter prospective cohort study, 5 urinary biomarkers (urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, urinary liver-type fatty acid binding protein, urinary interleukin-18, and cystatin C) were measured in 1,635 unselected emergency department patients at the time of hospital admission. We determined whether the biomarkers diagnosed intrinsic AKI and predicted adverse outcomes during hospitalization.
Results All biomarkers were elevated in intrinsic AKI, but urinary neutrophil gelatinase-associated lipocalin was most useful (81% specificity, 68% sensitivity at a 104-ng/ml cutoff) and predictive of the severity and duration of AKI. Intrinsic AKI was strongly associated with adverse in-hospital outcomes. Urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule 1 predicted a composite outcome of dialysis initiation or death during hospitalization, and both improved the net risk classification compared with conventional assessments. These biomarkers also identified a substantial subpopulation with low serum creatinine at hospital admission, but who were at risk of adverse events.
Conclusions Urinary biomarkers of nephron damage enable prospective diagnostic and prognostic stratification in the emergency department.

• 出版日期2012-1-17