Urine biomarkers give early prediction of acute kidney injury and outcome after out-of-hospital cardiac arrest

• Published in: Critical care (London, England) Vol. 20; no. 1; p. 314
• Main Authors: Beitland, Sigrid, Waldum-Grevbo, Bård Endre, Nakstad, Espen Rostrup, Berg, Jens-Petter, Trøseid, Anne-Marie Siebke, Brusletto, Berit Sletbakk, Brunborg, Cathrine, Andersen, Geir Øystein, Sunde, Kjetil
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05-10-2016; BioMed Central
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Aged; Biological markers; Biomarkers - urine; Cardiac arrest; Care and treatment; Chi-Square Distribution; Complications and side effects; Critical care; Cystatin C - analysis; Cystatin C - urine; Early Diagnosis; Female; Humans; Insulin-Like Growth Factor Binding Proteins - analysis; Insulin-Like Growth Factor Binding Proteins - urine; Kidney diseases; Lipocalin-2 - analysis; Lipocalin-2 - urine; Male; Middle Aged; Norway - epidemiology; Out-of-Hospital Cardiac Arrest - epidemiology; Out-of-Hospital Cardiac Arrest - mortality; Predictive Value of Tests; Prospective Studies; Risk Factors; Tissue Inhibitor of Metalloproteinase-2 - analysis; Tissue Inhibitor of Metalloproteinase-2 - urine; Biomarker; Prognosis; Acute kidney injury; Outcome; Cardiac arrest
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-016-1503-2

Post-resuscitation care after out-of-hospital cardiac arrest (OHCA) is challenging due to the threat of organ failure and difficult prognostication. Our aim was to examine whether urine biomarkers could give an early prediction of acute kidney injury (AKI) and outcome.
This was a prospective observational study of comatose OHCA patients at Oslo University Hospital Ullevål, Norway. Risk factors were clinical parameters and biomarkers measured in spot urine (cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and the product of tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7)) at admission and day 3. Outcome variables were AKI within 3 days using the Kidney Disease Improving Global Outcomes definition, 6-month mortality, and poor neurological outcome (PNO) defined as cerebral performance category 3-5.
Among 195 included patients (85 % males, mean age 60 years), 88 (45 %) died, 96 (49 %) had PNO, and 88 (45 %) developed AKI. In univariate analysis, increased urine cystatin C and NGAL concentration sampled at admission and day 3 were independent risk factors for AKI, mortality and PNO. Increased urine TIMP-2 × IGFBP7 levels was associated with AKI only at admission. In multivariate analyses combining clinical parameters and biomarker concentrations, the area under the receiver operating characteristics curve (AuROC) with 95 % confidence interval (CI) were 0.774 (0.700-0.848), 0.812 (0.751-0.873), and 0.819 (0.759-0.878) for AKI, mortality and PNO, respectively.
In comatose OHCA patients, urine levels of cystatin C and NGAL at admission and day 3 were independent risk factors for AKI, 6-month mortality and PNO.
Clinicaltrials.gov NCT01239420 . Registered 10 November 2010.