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ORIGINAL ARTICLE
Year : 2018  |  Volume : 18  |  Issue : 4  |  Page : 116-125

Predictive value of novel biomarkers for acute kidney injury in critically ill patients at Assiut University Hospitals


1 Department of Internal Medicine, Assiut University, Assuit, Egypt
2 Department of Anesthesia and Critical Care, Assiut University, Assuit, Egypt
3 Department of Biochemistry, Faculty of Medicine, Assiut University, Assuit, Egypt

Correspondence Address:
Dr. Effat A.E Tony
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jesnt.jesnt_28_18

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Introduction Acute kidney injury (AKI) is a clinical problem in critically ill patients, which is associated with adverse outcomes. There is a persistent need to find reliable biomarkers for the early diagnosis and prediction of AKI. Many genes are upregulated in the damaged kidneys, with the subsequent protein products appearing in the urine. Urinary liver-type fatty acid-binding protein (uL-FABP) and urinary kidney injury molecule-1 (uKIM-1) are among the promising upregulated biomarkers. Aim To assess the ability of uL-FABP in comparison with kidney injury molecule-1 for early prediction of AKI in adult critically ill patients. Patients and methods A cohort study was conducted enrolling 100 critically ill patients admitted to medical critical care units (CCUs) who had risk factors for developing AKI. Acute Physiology and Chronic Health Evaluation II score was calculated on admission. Serum creatinine was measured on admission and thereafter daily till the seventh day of CCU stay. Urine samples for uL-FABP and uKIM-1 assay were collected at the time of CCU admission, on day 3, and on day 5. Results Among critically ill patients, 60% had AKI diagnosed mostly on the second (53.3%) and third (40%) day of CCU admission. There was a significant difference in Acute Physiology and Chronic Health Evaluation II score (P<0.001), and duration of CCU stay (P<0.01) between AKI and non-AKI groups. The mean baseline of uKIM-1 was significantly higher in patients with AKI (7.17±1.56 ng/ml) compared with those without AKI (3.01±0.85 ng/ml; P=0.01). A significant high baseline uL-FABP level in patients with AKI was 168.51±45.98 (P<0.001). The area under the receiver operating characteristic curves of uKIM-1 and uL-FABP levels at the time of admission for prediction of AKI in critically ill patients within the first 7 days of their stay were 0.95 and 0.78, respectively, with a better predictive performance of uKIM-1 than uL-FABP. Conclusion UKIM-1 was a sensitive and specific biomarker (superior to uL-FABP) for the prediction of AKI in critically ill patients.


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