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2015 ; 62
(2
): 591-9
Nephropedia Template TP
gab.com Text
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Circulating Kidney Injury Molecule 1 Predicts Prognosis and Poor Outcome in
Patients With Acetaminophen-Induced Liver Injury
#MMPMID25891479
Antoine DJ
; Sabbisetti VS
; Francis B
; Jorgensen AL
; Craig DG
; Simpson KJ
; Bonventre JV
; Park BK
; Dear JW
Hepatology
2015[Aug]; 62
(2
): 591-9
PMID25891479
show ga
Acute kidney injury in the context of acetaminophen (APAP; paracetamol)-induced
liver injury is an important predictor of the requirement for urgent liver
transplantation (LT) to avoid death. However, the prognostic biomarker used to
report kidney dysfunction (serum creatinine concentration) has suboptimal
sensitivity and specificity. Kidney injury molecule 1 (KIM-1) can be quantified
in plasma as a sensitive and specific biomarker of kidney injury in both clinical
and preclinical studies. Therefore, plasma KIM-1 has potential as a sensitive
prognostic biomarker of patient outcome post-APAP overdose. In a cohort of APAP
overdose patients (N?=?74) with and without established liver injury, we
quantified plasma KIM-1 by immunoassay on the first day of admission to a LT unit
and assessed its diagnostic performance to predict outcome compared with serum
creatinine concentration. Day 1 plasma KIM-1 was significantly elevated in
patients that died or required LT, compared to spontaneous survivors (1,182?±?251
vs. 214?±?45 pg/mL; P?0.005). Receiver operator characteristic analysis
demonstrated the superiority of KIM-1 (area under the curve [AUC]: 0.87; 95%
confidence interval [CI]: 0.78-0.95; 0.56 sensitivity at 0.95 specificity),
compared with serum creatinine (AUC, 0.76; 95% CI: 0.64-0.87; 0.08 sensitivity at
0.95 specificity) and other current prognostic indicators, when measured on the
first day of enrollment into the study. Furthermore, KIM-1 was found to be a
statistically significant independent predictor of outcome at the 5% level
(P?0.0386) in a multivariable logistic regression model that considered all
measured factors (pseudo-R^2?=?0.895). CONCLUSION: Early measurement of plasma
KIM-1 represents a more sensitive predictor of patient outcome than serum
creatinine concentration post-APAP overdose. With further development, plasma
KIM-1 could significantly improve prognostic stratification.