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2016 ; 6
(ä): 33077
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Impact of clinical context on acute kidney injury biomarker performances:
differences between neutrophil gelatinase-associated lipocalin and L-type fatty
acid-binding protein
#MMPMID27605390
Asada T
; Isshiki R
; Hayase N
; Sumida M
; Inokuchi R
; Noiri E
; Nangaku M
; Yahagi N
; Doi K
Sci Rep
2016[Sep]; 6
(ä): 33077
PMID27605390
show ga
Application of acute kidney injury (AKI) biomarkers with consideration of
nonrenal conditions and systemic severity has not been sufficiently determined.
Herein, urinary neutrophil gelatinase-associated lipocalin (NGAL), L-type fatty
acid-binding protein (L-FABP) and nonrenal disorders, including inflammation,
hypoperfusion and liver dysfunction, were evaluated in 249 critically ill
patients treated at our intensive care unit. Distinct characteristics of NGAL and
L-FABP were revealed using principal component analysis: NGAL showed linear
correlations with inflammatory markers (white blood cell count and C-reactive
protein), whereas L-FABP showed linear correlations with hypoperfusion and
hepatic injury markers (lactate, liver transaminases and bilirubin). We thus
developed a new algorithm by combining urinary NGAL and L-FABP with
stratification by the Acute Physiology and Chronic Health Evaluation score,
presence of sepsis and blood lactate levels to improve their AKI predictive
performance, which showed a significantly better area under the receiver
operating characteristic curve [AUC-ROC 0.940; 95% confidential interval (CI)
0.793-0.985] than that under NGAL alone (AUC-ROC 0.858, 95% CI 0.741-0.927,
P?=?0.03) or L-FABP alone (AUC-ROC 0.837, 95% CI 0.697-0.920, P?=?0.007) and
indicated that nonrenal conditions and systemic severity should be considered for
improved AKI prediction by NGAL and L-FABP as biomarkers.