Urinary Liver-Type Fatty Acid-Binding Protein Level as a Predictive Biomarker of Acute Kidney Injury in Patients with Acute Decompensated Heart Failure

Hishikari, Keiichi; Hikita, Hiroyuki; Nakamura, S.; Nakagama, Shun; Mizusawa, Masahumi; Yamamoto, Tasuku; Doi, Junichi; Hayashi, Yosuke; Utsugi, Yuya; Araki, Makoto; Sudo, Yasuhiko; Kimura, Shigeki; Takahashi, Atsushi; Ashikaga, Takashi; Isobe, Mitsuaki

doi:10.1159/000476002

Cited by 23 publications

(15 citation statements)

References 27 publications

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“…It should be noted that we measured urinary L-FABP only at the point of admission to the CICU. The decision for this was based on reports of whether this is the best time for predicting AKI in patients with acute decompensated heart failure [ 36 ] or whether it is after cardiac surgery [ 37 ]. Thus, although we showed that admission measurements of urinary L-FABP may help physicians predict AKI, we do not know whether L-FABP, NT-proBNP, or a combination of both could also be used for monitoring markers.…”

Section: Discussionmentioning

confidence: 99%

Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units

et al. 2018

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BackgroundThe early prediction of acute kidney injury (AKI) can facilitate timely intervention and prevent complications. We aimed to understand the predictive value of urinary liver-type fatty-acid binding protein (L-FABP) levels on admission to medical (non-surgical) cardiac intensive care units (CICUs) for AKI, both independently and in combination with serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.MethodsWe prospectively investigated the predictive value of L-FABP and NT-proBNP for AKI in a large, heterogeneous cohort of patients treated in medical CICUs. Baseline urinary L-FABP and serum NT-proBNP were measured on admission. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. We studied 1273 patients (mean age, 68 years), among whom 46% had acute coronary syndromes, 38% had acute decompensated heart failure, 5% had arrhythmia, 3% had pulmonary hypertension, 2% had acute aortic syndrome, 2% had infective endocarditis, and 1% had Takotsubo cardiomyopathy.ResultsUrinary L-FABP levels correlated with serum NT-proBNP levels (r = 0.17, p < 0.0001). AKI occurred in 224 patients (17.6%), including 48 patients with stage 2 or 3 disease. Patients who developed AKI had higher one-week and 6-month mortality than those who did not develop AKI (p = 0.0002 and p = 0.003, respectively). In the multivariate logistic analysis, both L-FABP (p < 0.0001) and NT-proBNP (p = 0.006) were independently associated with the development of AKI. Adding L-FABP and NT-proBNP to a baseline model that included established risk factors further improved reclassification (p < 0.001) and discrimination (p < 0.01) beyond that of the baseline model or any single biomarker individually.ConclusionsUrinary L-FABP and serum NT-proBNP levels on admission are independent predictors of AKI, and when used in combination, improve early prediction of AKI in patients hospitalized at medical CICUs.

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Section: Discussionmentioning

confidence: 99%

Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units

et al. 2018

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“…23 Matsumori et al 24 found that in patients with ACS high L-FABP may be useful in identifying high-risk patients for future cardiovascular events. In another study, Hishikari et al 25 examined 281 consecutive patients with acutely decompensated HF and found that L-FABP is useful for predicting the onset of acute kidney injury. Indeed, L-FABP is involved in acute kidney tubular necrosis and chronic kidney failure.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, these four proteins reflect multiorgan dysfunction, as well as systemic inflammation and immune activation. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] During the early hours of CS, changes in the expression of these proteins may precede overt multiorgan failure and identify patients at a higher mortality risk. These data highlight the relevance of systemic involvement in CS, beyond primary pump failure.…”

Section: Discussionmentioning

confidence: 99%

Protein-based cardiogenic shock patient classifier

Rueda

Borràs

García-García

et al. 2019

European Heart Journal

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Aims Cardiogenic shock (CS) is associated with high short-term mortality and a precise CS risk stratification could guide interventions to improve patient outcome. Here, we developed a circulating protein-based score to predict short-term mortality risk among patients with CS. Methods and results Mass spectrometry analysis of 2654 proteins was used for screening in the Barcelona discovery cohort (n = 48). Targeted quantitative proteomics analyses (n = 51 proteins) were used in the independent CardShock cohort (n = 97) to derive and cross-validate the protein classifier. The combination of four circulating proteins (Cardiogenic Shock 4 proteins—CS4P), discriminated patients with low and high 90-day risk of mortality. CS4P comprises the abundances of liver-type fatty acid-binding protein, beta-2-microglobulin, fructose-bisphosphate aldolase B, and SerpinG1. Within the CardShock cohort used for internal validation, the C-statistic was 0.78 for the CardShock risk score, 0.83 for the CS4P model, and 0.84 (P = 0.033 vs. CardShock risk score) for the combination of CardShock risk score with the CS4P model. The CardShock risk score with the CS4P model showed a marked benefit in patient reclassification, with a net reclassification improvement (NRI) of 0.49 (P = 0.020) compared with CardShock risk score. Similar reclassification metrics were observed in the IABP-SHOCK II risk score combined with CS4P (NRI =0.57; P = 0.032). The CS4P patient classification power was confirmed by enzyme-linked immunosorbent assay (ELISA). Conclusion A new protein-based CS patient classifier, the CS4P, was developed for short-term mortality risk stratification. CS4P improved predictive metrics in combination with contemporary risk scores, which may guide clinicians in selecting patients for advanced therapies.

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“…53,54 Increased urinary concentrations of L-FABP have also been described in adults with acute decompensated heart failure or surgically treated aortic aneurysm. 55,56 To date, a single promising report has been published on urinary L-FABP as a marker of AKI risk in adult patients following HSCT. 57…”

Section: New Acute Kidney Injury Indexes Liver-type Fatty Acid-bindinmentioning

confidence: 99%

Markers of acute kidney injury in children undergoing hematopoietic stem cell transplantation

Augustynowicz¹,

Bargenda-Lange²,

Kałwak³

et al. 2019

Adv Clin Exp Med

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Acute kidney injury (AKI), one of the major complications in children undergoing hematopoietic stem cell transplantation (HSCT), is an independent predictor of the patient's survival and a prognostic factor of progression to chronic kidney disease (CKD). Despite the multifaceted role of AKI, its early diagnosis in the course of HSCT remains a challenge. These difficulties may result from the inefficiency of traditional methods used to assess kidney function, like serum creatinine or estimated glomerular filtration rate. Moreover, the list of potential AKI markers tested in HSCT conditions is limited and does not involve indexes evaluated in the pediatric population. This review summarizes current knowledge on the pathophysiology of AKI developing in the course of HSCT; presents well-known markers of AKI that are potentially applicable in children who have undergone HSCT; discusses the role of new markers in diagnosing AKI and predicting the renal outcome in children undergoing HSCT; and analyzes the prospects for the use of new tools for assessing kidney injury in everyday clinical practice.

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Urinary Liver-Type Fatty Acid-Binding Protein Level as a Predictive Biomarker of Acute Kidney Injury in Patients with Acute Decompensated Heart Failure

Cited by 23 publications

References 27 publications

Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units

Predicting acute kidney injury using urinary liver-type fatty-acid binding protein and serum N-terminal pro-B-type natriuretic peptide levels in patients treated at medical cardiac intensive care units

Protein-based cardiogenic shock patient classifier

Markers of acute kidney injury in children undergoing hematopoietic stem cell transplantation

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