Abstract
BackgroundRenal dysfunction is an established predictor of all-cause mortality in intensive care units. This study analyzed the outcomes of coronary care unit (CCU) patients and evaluated several biomarkers of acute kidney injury (AKI), including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18) and cystatin C (CysC) on the first day of CCU admission.Methodology/Principal FindingsSerum and urinary samples collected from 150 patients in the coronary care unit of a tertiary care university hospital between September 2009 and August 2010 were tested for NGAL, IL-18 and CysC. Prospective demographic, clinical and laboratory data were evaluated as predictors of survival in this patient group. The most common cause of CCU admission was acute myocardial infarction (80%). According to Acute Kidney Injury Network criteria, 28.7% (43/150) of CCU patients had AKI of varying severity. Cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.05) between patients with AKI versus those without AKI. For predicting AKI, serum CysC displayed an excellent areas under the receiver operating characteristic curve (AUROC) (0.895±0.031, p<0.001). The overall 180-day survival rate was 88.7% (133/150). Multiple Cox logistic regression hazard analysis revealed that urinary NGAL, serum IL-18, Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) and sodium on CCU admission day one were independent risk factors for 6-month mortality. In terms of 6-month mortality, urinary NGAL had the best discriminatory power, the best Youden index, and the highest overall correctness of prediction.ConclusionsOur data showed that serum CysC has the best discriminative power for predicting AKI in CCU patients. However, urinary NGAL and serum IL-18 are associated with short-term mortality in these critically ill patients.
Highlights
Acute kidney injury (AKI) that develops after admission to coronary care unit (CCU) is associated with very poor outcomes [1,2]
Our data showed that serum cystatin C (CysC) has the best discriminative power for predicting acute kidney injury (AKI) in CCU patients
Urinary neutrophil gelatinase-associated lipocalin (NGAL) and serum IL-18 are associated with short-term mortality in these critically ill patients
Summary
Acute kidney injury (AKI) that develops after admission to coronary care unit (CCU) is associated with very poor outcomes [1,2]. Serum creatinine (SCr), is a poor marker of early renal dysfunction because serum concentration is greatly influenced by changes in muscle mass and tubular secretion [5,6]. The aim of this study was to identify the relationship between AKI/short-term prognosis and AKI biomarkers in CCU patients including serum and urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18). This study analyzed the outcomes of coronary care unit (CCU) patients and evaluated several biomarkers of acute kidney injury (AKI), including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18) and cystatin C (CysC) on the first day of CCU admission
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