Elevated urinary kidney injury molecule 1 at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

• Published in: Polskie archiwum medycyny wewne̦trznej Vol. 132; no. 9
• Main Authors: Josa-Laorden, Claudia, Rubio-Gracia, Jorge, Sánchez-Marteles, Marta, Torcal, Pilar, Garcés-Horna, Vanesa, Sola-Martínez, Anna, Íñigo, Pablo, Giménez-López, Ignacio, Pérez-Calvo, Juan I
• Format: Journal Article
• Language: English
• Published: Poland 26-09-2022
• Subjects: Acute Kidney Injury; Biomarkers; Creatinine; Cystatin C; Gelatinases; Heart Failure; Humans; Interleukin-18; Kidney; Lipocalin-2 - urine; Patient Discharge; Prospective Studies; Urea
• ISSN: 1897-9483
• DOI: 10.20452/pamw.16284

Hospitalization for acute decompensation of heart failure (ADHF) is a frequent event associated with long‑term adverse effects. Prognosis is even worse if acute kidney injury (AKI) occurs during hospitalization.
The study aimed to determine whether kidney damage biomarkers neutrophil gelatinase‑associatedlipocalin (NGAL), kidney injury molecule 1 (KIM‑1), and interleukin18 (IL‑18) might predict AKI and have prognostic value in ADHF.
Serum NGAL on admission and urine NGAL, KIM‑1, and IL‑18 on discharge were determined in 187 ADHF patients enrolled in a prospective, observational, unblinded study. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. Patients were followedfor 12 months to record all‑cause mortality.
A total of 22% patients died during the follow‑up, with 52.5% dying within 4 months after discharge. Serum NGAL (P <0.001), urine NGAL (P = 0.047), and urinary KIM‑1 (P = 0.014) levels were significantly higher in the deceased patients at discharge. After adjustment for estimated glomerular filtration rate (eGFR), only urinary KIM‑1 independently predicted mortality at month 4 (hazard ratio [HR], 3.166; 95% CI, 1.203-8.334; P = 0.020) and month 12 (HR, 1.969; 95% CI, 1.123-3.454; P = 0.018) in Cox regression models. In receiver operating characteristic (ROC) analysis urinary KIM‑1 (area under the ROC curve [AUC] = 0.830) outperformed other markers of renal function. The Kaplan-Meier survival analysis showed KIM‑1 predictive value as additive to that of AKI incidence and admission eGFR. Admission serum NGAL was higher in AKI patients (P ≤0.001) with a modest diagnostic performance (AUC = 0.667), below that of urea (AUC = 0.732), creatinine (AUC = 0.696), or cystatin C (AUC = 0.676).
Discharge urinary KIM‑1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF.