Abstract
We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patients (mean age; 68 years) treated at medical (non-surgical) cardiac intensive care units (CICUs). Patients with stage 5 chronic kidney disease were excluded from the study. Of these patients, 47% had acute coronary syndrome and 38% had acute decompensated heart failure. The creatinine-defined AKI was diagnosed according to the “Kidney Disease: Improving Global Outcomes” criteria. The primary endpoint was a composite of all-cause death or progression to end-stage kidney disease, indicating the initiation of maintenance dialysis therapy or kidney transplantation. Creatinine-defined AKI occurred in 207 patients, with 44 patients having stage 2 or 3 disease. During a mean follow-up period of 41 months after enrollment, the primary endpoint occurred in 242 patients. Multivariate Cox regression analyses revealed L-FABP levels as independent predictors of the primary endpoint (p < 0.001). Adding L-FABP to a baseline model with established risk factors further enhanced reclassification and discrimination beyond that of the baseline model alone, for primary-endpoint prediction (both; p < 0.01). On Kaplan–Meier analyses, increased L-FABP (≥4th quintile value of 9.0 ng/mL) on admission or presence of creatinine-defined AKI, correlated with an increased risk of the primary endpoint (p < 0.001). Thus, urinary L-FABP levels on admission are potent and independent predictors of long-term adverse outcomes, and they might improve the long-term risk stratification of patients admitted at medical CICUs, when used in combination with creatinine-defined AKI.
Highlights
Liver-type fatty-acid-binding protein (L-FABP; molecular weight, 14,000) is expressed in the proximal tubular epithelial cells [1] and binds to free fatty acids in the cytoplasm [2,3]
In a heterogeneous cohort of patients treated in medical cardiac intensive care units (CICUs), urinary L-FABP levels were found to be potent predictors of acute kidney injury (AKI) [5,6]
This study prospectively investigated the prognostic value of urinary L-FABP levels on admission, both independently and in combination with creatinine-defined AKI, in patients hospitalized at medical CICUs
Summary
Liver-type fatty-acid-binding protein (L-FABP; molecular weight, 14,000) is expressed in the proximal tubular epithelial cells [1] and binds to free fatty acids in the cytoplasm [2,3]. In a heterogeneous cohort of patients treated in medical (nonsurgical) cardiac intensive care units (CICUs), urinary L-FABP levels were found to be potent predictors of acute kidney injury (AKI) [5,6]. To date, the association between urinary L-FABP levels and long-term adverse outcomes in patients treated at medical CICUs remains poorly understand. “subclinical AKI”, as evidenced by increased urinary tubular injury markers without serum creatinine increase, is associated with severe in-hospital clinical outcomes [10]. Only few studies of patients after cardiac surgery have reported that tubular injury marker combined with creatinine-defined AKI status could predict the increased risk of long-term adverse outcomes [11,12]
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