Abstract 13623: Predicting Acute Kidney Injury Using Biomarkers of Renal Injury Following Cardiac Arrest

Abstract

Aim: Acute kidney injury (AKI) after cardiac arrest (CA) is common and associated with worse outcomes. We aimed to evaluate the performance of kidney specific biomarkers including kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and cystatin-C in predicting AKI post-CA as compared to serum creatinine. Methods: Patients with kidney specific biomarkers collected as part of randomized trials conducted in adult post-CA populations (NCT02260258, NCT01319110) were included. Patients with Kidney Disease Improving Global Outcome (KDIGO) stage III AKI immediately after enrollment and patients not enrolled at the coordinating center were excluded. Creatinine, KIM-1, NGAL and cystatin-C were measured immediately before enrollment. The primary outcome measure was KDIGO stage III AKI in the first 7-days after enrollment. We determined the association and discrimination of renal biomarkers with relation to KDIGO stage III AKI. Results: Of 63 patients included, 12 (19.1%) developed stage III AKI and 40 (63.5%) died prior to hospital discharge. As compared to patients who did not develop stage III AKI, those who developed stage III AKI had higher baseline serum creatinine (1.75 [IQR:1.3, 2.75] vs 1.3 [1.1, 1.7], p=0.04), higher NGAL (879 [IQR: 442,1194] vs 234 [IQR: 163, 482], p<0.001) and higher cystatin-C (2567 [IQR: 1222,3835] vs 1248 [IQR: 808,1691], p=0.01). There was no difference in KIM-1 (-1.70 [IQR: -2.79, -0.40] vs -1.87 [IQR: -2.70, -1.27], p=0.57). Of the various biomarkers, NGAL measured early after return of spontaneous circulation had the highest discrimination for the future development of stage III AKI [AUROC 0.81 (95%CI:0.69-0.93)] as compared to creatinine [AUROC 0.69 (95%CI: 0.51-0.87)], and cystatin-C [AUROC 0.74 (95%CI:0.57-0.90)] though the difference in AUROC was not significant (p>0.05 for all comparisons). KIM-1 had lowest discrimination [AUROC 0.55 (95%CI:0.34-0.76)]. Conclusion: In post-CA patients enrolled in the two clinical trials, NGAL measured early after CA had the highest discrimination for the development of stage III AKI though the discrimination was not significant compared to creatinine possibly due to small sample size.