The clinical utility window for acute kidney injury biomarkers in the critically ill

Introduction: Acute Kidney Injury (AKI) biomarker utility depends on sample timing after the onset of renal injury. We compared biomarker performance on arrival in the emergency department (ED) with subsequent performance in the intensive care unit (ICU).Methods: Urinary and plasma Neutrophil Gelati...

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Main Authors:	Md Ralib, Azrina, Pickering, John W., Shaw, Geoffrey M., Than, Martin P, George, Peter M, Endre, Zoltan H.
Format:	Article
Language:	English English English English
Published:	BioMed Central The Open Access Publisher 2014
Subjects:	R Medicine (General) RC86 First aid in illness and injury
Online Access:	http://irep.iium.edu.my/39174/ http://irep.iium.edu.my/39174/ http://irep.iium.edu.my/39174/1/s13054-014-0601-2.pdf http://irep.iium.edu.my/39174/4/s13054-014-0601-2_published_version.pdf http://irep.iium.edu.my/39174/7/39174-The%20clinical%20utility%20window%20for%20acute%20kidney%20injury%20biomarkers_SCOPUS.pdf http://irep.iium.edu.my/39174/8/39174-The%20clinical%20utility%20window%20for%20acute%20kidney%20injury%20biomarkers-WOS.pdf

id	iium-39174
recordtype	eprints
spelling	iium-391742017-09-25T04:01:43Z http://irep.iium.edu.my/39174/ The clinical utility window for acute kidney injury biomarkers in the critically ill Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Than, Martin P George, Peter M Endre, Zoltan H. R Medicine (General) RC86 First aid in illness and injury Introduction: Acute Kidney Injury (AKI) biomarker utility depends on sample timing after the onset of renal injury. We compared biomarker performance on arrival in the emergency department (ED) with subsequent performance in the intensive care unit (ICU).Methods: Urinary and plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL), and urinary Cystatin C (CysC), alkaline phosphatase, Gamma-Glutamyl Transpeptidase (GGT), ?- and ?-Glutamyl S-Transferase (GST), and albumin were measured on ED presentation, and at 0, 4, 8, and 16 hours, and days 2, 4 and 7 in the ICU in patients after cardiac arrest, sustained or profound hypotension or ruptured abdominal aortic aneurysm. AKI was defined as plasma creatinine increase > 26.5 umol/l within 48 hours or >50% within 7 days. Results: In total, 45 of 77 patients developed AKI. Most AKI patients had elevated urinary NGAL, and plasma NGAL and CysC in the period 6 to 24 hours post presentation. Biomarker performance in the ICU was similar or better than when measured earlier in the ED. Plasma NGAL diagnosed AKI at all sampling times, urinary NGAL, plasma and urinary CysC up to 48 hours, GGT 4 to 12?hours, and ?-GST 8 to 12 hours post insult. Thirty-one patients died or required dialysis. Peak 24-hour urinary NGAL and albumin independently predicted 30-day mortality and dialysis; odds ratios 2.87 (1.32 to 6.26), and 2.72 (1.14 to 6.48), respectively. Urinary NGAL improved risk prediction by 11% (IDIevent of 0.06 (0.002 to 0.19) and IDInon-event of 0.04 (0.002 to 0.12)).Conclusion: Early measurement in the ED has utility, but not better AKI diagnostic performance than later ICU measurement. Plasma NGAL diagnosed AKI at all time points. Urinary NGAL best predicted mortality or dialysis compared to other biomarkers. BioMed Central The Open Access Publisher 2014 Article PeerReviewed application/pdf en http://irep.iium.edu.my/39174/1/s13054-014-0601-2.pdf application/pdf en http://irep.iium.edu.my/39174/4/s13054-014-0601-2_published_version.pdf application/pdf en http://irep.iium.edu.my/39174/7/39174-The%20clinical%20utility%20window%20for%20acute%20kidney%20injury%20biomarkers_SCOPUS.pdf application/pdf en http://irep.iium.edu.my/39174/8/39174-The%20clinical%20utility%20window%20for%20acute%20kidney%20injury%20biomarkers-WOS.pdf Md Ralib, Azrina and Pickering, John W. and Shaw, Geoffrey M. and Than, Martin P and George, Peter M and Endre, Zoltan H. (2014) The clinical utility window for acute kidney injury biomarkers in the critically ill. Critical Care, 18 (601). pp. 1-12. ISSN 1466-609X http://ccforum.com/content/18/6/601/abstract
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English English English
topic	R Medicine (General) RC86 First aid in illness and injury
spellingShingle	R Medicine (General) RC86 First aid in illness and injury Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Than, Martin P George, Peter M Endre, Zoltan H. The clinical utility window for acute kidney injury biomarkers in the critically ill
description	Introduction: Acute Kidney Injury (AKI) biomarker utility depends on sample timing after the onset of renal injury. We compared biomarker performance on arrival in the emergency department (ED) with subsequent performance in the intensive care unit (ICU).Methods: Urinary and plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL), and urinary Cystatin C (CysC), alkaline phosphatase, Gamma-Glutamyl Transpeptidase (GGT), ?- and ?-Glutamyl S-Transferase (GST), and albumin were measured on ED presentation, and at 0, 4, 8, and 16 hours, and days 2, 4 and 7 in the ICU in patients after cardiac arrest, sustained or profound hypotension or ruptured abdominal aortic aneurysm. AKI was defined as plasma creatinine increase > 26.5 umol/l within 48 hours or >50% within 7 days. Results: In total, 45 of 77 patients developed AKI. Most AKI patients had elevated urinary NGAL, and plasma NGAL and CysC in the period 6 to 24 hours post presentation. Biomarker performance in the ICU was similar or better than when measured earlier in the ED. Plasma NGAL diagnosed AKI at all sampling times, urinary NGAL, plasma and urinary CysC up to 48 hours, GGT 4 to 12?hours, and ?-GST 8 to 12 hours post insult. Thirty-one patients died or required dialysis. Peak 24-hour urinary NGAL and albumin independently predicted 30-day mortality and dialysis; odds ratios 2.87 (1.32 to 6.26), and 2.72 (1.14 to 6.48), respectively. Urinary NGAL improved risk prediction by 11% (IDIevent of 0.06 (0.002 to 0.19) and IDInon-event of 0.04 (0.002 to 0.12)).Conclusion: Early measurement in the ED has utility, but not better AKI diagnostic performance than later ICU measurement. Plasma NGAL diagnosed AKI at all time points. Urinary NGAL best predicted mortality or dialysis compared to other biomarkers.
format	Article
author	Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Than, Martin P George, Peter M Endre, Zoltan H.
author_facet	Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Than, Martin P George, Peter M Endre, Zoltan H.
author_sort	Md Ralib, Azrina
title	The clinical utility window for acute kidney injury biomarkers in the critically ill
title_short	The clinical utility window for acute kidney injury biomarkers in the critically ill
title_full	The clinical utility window for acute kidney injury biomarkers in the critically ill
title_fullStr	The clinical utility window for acute kidney injury biomarkers in the critically ill
title_full_unstemmed	The clinical utility window for acute kidney injury biomarkers in the critically ill
title_sort	clinical utility window for acute kidney injury biomarkers in the critically ill
publisher	BioMed Central The Open Access Publisher
publishDate	2014
url	http://irep.iium.edu.my/39174/ http://irep.iium.edu.my/39174/ http://irep.iium.edu.my/39174/1/s13054-014-0601-2.pdf http://irep.iium.edu.my/39174/4/s13054-014-0601-2_published_version.pdf http://irep.iium.edu.my/39174/7/39174-The%20clinical%20utility%20window%20for%20acute%20kidney%20injury%20biomarkers_SCOPUS.pdf http://irep.iium.edu.my/39174/8/39174-The%20clinical%20utility%20window%20for%20acute%20kidney%20injury%20biomarkers-WOS.pdf
first_indexed	2023-09-18T20:56:16Z
last_indexed	2023-09-18T20:56:16Z
_version_	1777410324811481088

The clinical utility window for acute kidney injury biomarkers in the critically ill

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