Urine Biomarkers Predict Acute Kidney Injury and Mortality in Very Low Birth Weight Infants

• Published in: The Journal of pediatrics Vol. 159; no. 6; pp. 907 - 912.e1
• Main Authors: Askenazi, David J., MD, MSPH, Montesanti, Angela, MPH, Hunley, Hayden, MPH, Koralkar, Rajesh, MPH, MBBS, Pawar, Pushkar, MBBS, MPH, Shuaib, Faisal, MD, MPH, Liwo, Amandiy, MD, Devarajan, Prasad, MD, Ambalavanan, Namasivayam, MD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.12.2011; Mosby, Inc; Elsevier
• Subjects: Acute Kidney Injury - mortality; Acute Kidney Injury - urine; Biological and medical sciences; biomarkers; Biomarkers - urine; blood serum; Case-Control Studies; creatinine; death; Epidemiology; Female; General aspects; gestational age; Humans; Infant, Newborn; Infant, Very Low Birth Weight; infants; Kidneys; low birth weight; Male; Medical sciences; mortality; Nephrology. Urinary tract diseases; osteopontin; Pediatrics; Predictive Value of Tests; Prognosis; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Urinary system involvement in other diseases. Miscellaneous; urine; Cystatin-C; NGAL; SCr; VLBW; Acute kidney injury; Serum creatinine; Very low birth weight; ROC; Osteopontin; OPN; AUC; KIM-1; B2mG; Beta-2 microglobulin; Area under the curve; IL-18; Receiver operator characteristics; Cys-C; Interleukin-18; Neutrophil gelatinase associated lipocalin; AKI; Kidney injury molecule-1; Human; Kidney disease; Premature; Urine; Pediatrics; Urinary system disease; Pregnancy disorders; Mortality; Prediction; Biological marker; Infant; Epidemiology; Very low birthweight; Newborn diseases; Prematurity; Predictive factor
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2011.05.045

Objectives To test the hypothesis that noninvasive urinary biomarkers may improve early identification, differentiate causes, and predict outcomes of acute kidney injury (AKI) in very low birth weight subjects. Study design We performed 2 nested case-control studies to compare the ability of 6 urine biomarkers to predict AKI (rise in serum creatinine of at least 0.3 mg/dL) and mortality (death before 36 weeks postmenstrual age). Results Compared to subjects without AKI (n = 21), those with AKI (n = 9) had higher maximum neutrophil gelatinase-associated lipocalin (OR = 1.2 [1.0, 1.6]; P < .01; receiver operator characteristics [ROC] area under the curve [AUC] = .80) and higher maximum osteopontin (OR = 3.2 [1.5, 9.9]; P < .01; ROC AUC = 0.83). Compared with survivors (n = 100), nonsurvivors (n = 23) had higher maximum kidney injury molecule 1 (OR = 1.1 [1.0, 1.2]; P < .02; ROC AUC = 0.64) and higher maximum osteopontin (OR = 1.8 (1.2, 2.7); P < .001; AUC of ROC = 0.78). The combination of biomarkers improved predictability for both AKI and mortality. Controlling for gestational age and birth weight did not affect results considerably. Conclusions Urinary biomarkers can predict AKI and mortality in very low birth weight infants independent of gestational age and birth weight.