Performance of Kidney Injury Molecule-1 and Liver Fatty Acid-Binding Protein and Combined Biomarkers of AKI after Cardiac Surgery

• Published in: Clinical journal of the American Society of Nephrology Vol. 8; no. 7; pp. 1079 - 1088
• Main Authors: Parikh, Chirag R, Thiessen-Philbrook, Heather, Garg, Amit X, Kadiyala, Deepak, Shlipak, Michael G, Koyner, Jay L, Edelstein, Charles L, Devarajan, Prasad, Patel, Uptal D, Zappitelli, Michael, Krawczeski, Catherine D, Passik, Cary S, Coca, Steven G
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.07.2013
• Subjects: Academic Medical Centers; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Acute Kidney Injury - urine; Acute-Phase Proteins - urine; Aged; Area Under Curve; Biomarkers - urine; Cardiac Surgical Procedures - adverse effects; Child, Preschool; Early Diagnosis; Fatty Acid-Binding Proteins - urine; Female; Hepatitis A Virus Cellular Receptor 1; Humans; Infant; Interleukin-18 - urine; Linear Models; Lipocalin-2; Lipocalins - urine; Logistic Models; Male; Membrane Glycoproteins - urine; Middle Aged; North America; Original; Predictive Value of Tests; Prognosis; Prospective Studies; Proto-Oncogene Proteins - urine; Receptors, Virus; Risk Factors; ROC Curve
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.10971012

AKI is common and novel biomarkers may help provide earlier diagnosis and prognosis of AKI in the postoperative period. This was a prospective, multicenter cohort study involving 1219 adults and 311 children consecutively enrolled at eight academic medical centers. Performance of two urine biomarkers, kidney injury molecule-1 (KIM-1) and liver fatty acid-binding protein (L-FABP), alone or in combination with other injury biomarkers during the perioperative period was evaluated. AKI was defined as doubling of serum creatinine or need for acute dialysis. KIM-1 peaked 2 days after surgery in adults and 1 day after surgery in children, whereas L-FABP peaked within 6 hours after surgery in both age groups. In multivariable analyses, the highest quintile of the first postoperative KIM-1 level was associated with AKI compared with the lowest quintile in adults, whereas the first postoperative L-FABP was not associated with AKI. Both KIM-1 and L-FABP were not significantly associated with AKI in adults or children after adjusting for other kidney injury biomarkers (neutrophil gelatinase-associated lipocalin and IL-18). The highest area under the curves achievable for discrimination for AKI were 0.78 in adults using urine KIM-1 from 6 to 12 hours, urine IL-18 from day 2, and plasma neutrophil gelatinase-associated lipocalin from day 2 and 0.78 in children using urine IL-18 from 0 to 6 hours and urine L-FABP from day 2. Postoperative elevations of KIM-1 associate with AKI and adverse outcmes in adults but were not independent of other AKI biomarkers. A panel of multiple biomarkers provided moderate discrimination for AKI.