Diagnostic performance of plasma and urine neutrophil gelatinase-associated lipocalin, cystatin C, and creatinine for acute kidney injury in burn patients: A prospective cohort study

Abstract

BackgroundDiagnosing acute kidney injury quickly is imperative since it is known as an independent risk factor for mortality in burn patients. We evaluated the diagnostic power of creatinine, cystatin, serum and urine neutrophil gelatinase-associated lipocalin at different time periods and observed the changes from baseline for each biomarker.MethodsThis was a prospective observation study from January 2015 to February 2016. A total of 84 patients were enrolled consecutively. Serum creatinine, serum cystatin C, and serum and urine neutrophil gelatinase-associated lipocalin were measured at admission, 7th, 14th, 21st, and 28th days after admission. All samples were collected until acute kidney injury developed.ResultsAcute kidney injury developed in 35 patients. The mean age was 49.6 years with a male predominance. The median urine neutrophil gelatinase-associated lipocalin was the lowest (11.6 ng/dL) at admission, and the highest at 85.5 ng/dL on day 7. Mean creatinine level was the highest (0.88 mg/dL) at admission and the median creatinine level was the lowest (0.56 mg/dL) on the 14th day. The area under the curve of creatinine levels was the highest with 0.857 during the 1st week. The area under the curve of urine neutrophil gelatinase-associated lipocalin was the highest with 0.803 during the 5th week.ConclusionsWithin 1 week of acute kidney injury, creatinine level was the optimal biomarker for diagnosis while urine neutrophil gelatinase-associated lipocalin showed better diagnostic performance following the 4- week period.

Time-varying discrimination accuracy of longitudinal biomarkers for the prediction of mortality compared to assessment at fixed time point in severe burns patients

“…This could be because lactate further reflects the severity of burn than that of mortality. Creatinine is also a better risk factor of AKI rather than that of mortality [ 18 ]. However, creatinine showed high discrimination, with a c-index of 0.828.…”

Time-varying Discrimination Accuracy of Longitudinal Biomarkers for the Prediction of Mortality Compared to Assessment at Fixed Time Point in Severe Burns Patients

“…This could be because lactate further re ects the severity of burn than that of mortality. Creatinine is also a better risk factor of AKI rather than that of mortality (16). However, creatinine showed high discrimination, with a c-index of 0.828.…”

Time-Varying Discrimination Accuracy of Longitudinal Biomarkers for the Prediction of Mortality Compared to Assessment at Fixed Time Point in Severe Burns Patients

“…We infer that this could be because lactate further re ects the severity of the burn than mortality. Creatinine is also a better risk factor of acute kidney injury (AKI) rather than mortality (16). However, creatinine showed high discrimination with c-index of 0.828.…”