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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Evaluation of clinically available renal biomarkers in critically ill adults: a prospective multicenter observational study

Authors: Yujun Deng, Ruibin Chi, Shenglong Chen, Heng Ye, Jie Yuan, Lin Wang, Yiling Zhai, Lu Gao, Danqing Zhang, Linhui Hu, Bo Lv, Yi Long, Cheng Sun, Xiaobing Yang, Xia Zou, Chunbo Chen

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Although serum cystatin C (sCysC), urinary N-acetyl-β-d-glucosaminidase (uNAG), and urinary albumin/creatinine ratio (uACR) are clinically available, their optimal combination for acute kidney injury (AKI) detection and prognosis prediction remains unclear. We aimed to assess the discriminative abilities of these biomarkers and their possible combinations for AKI detection and intensive care unit (ICU) mortality prediction in critically ill adults.

Methods

A multicenter, prospective observational study was conducted in mixed medical-surgical ICUs at three tertiary care hospitals. One thousand eighty-four adult critically ill patients admitted to the ICUs were studied. We assessed the use of individual biomarkers (sCysC, uNAG, and uACR) measured at ICU admission and their combinations with regard to AKI detection and prognosis prediction.

Results

AUC-ROCs for sCysC, uNAG, and uACR were calculated for total AKI (0.738, 0.650, and 0.683, respectively), severe AKI (0.839, 0.706, and 0.771, respectively), and ICU mortality (0.727, 0.793, and 0.777, respectively). The panel of sCysC plus uNAG detected total and severe AKI with significantly higher accuracy than either individual biomarkers or the other two panels (uNAG plus uACR or sCysC plus uACR). For detecting total AKI, severe AKI, and ICU mortality at ICU admission, this panel yielded AUC-ROCs of 0.756, 0.863, and 0.811, respectively; positive predictive values of 0.71, 0.31, and 0.17, respectively; and negative predictive values of 0.81, 0.97, and 0.98, respectively. Moreover, this panel significantly contributed to the accuracy of the clinical models for AKI detection and ICU mortality prediction, as measured by the AUC-ROC, continuous net reclassification index, and incremental discrimination improvement index. The comparable performance of this panel was further confirmed with bootstrap internal validation.

Conclusions

The combination of a functional marker (sCysC) and a tubular damage marker (uNAG) revealed significantly superior discriminative performance for AKI detection and yielded additional prognostic information on ICU mortality.
Appendix
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Metadata
Title
Evaluation of clinically available renal biomarkers in critically ill adults: a prospective multicenter observational study
Authors
Yujun Deng
Ruibin Chi
Shenglong Chen
Heng Ye
Jie Yuan
Lin Wang
Yiling Zhai
Lu Gao
Danqing Zhang
Linhui Hu
Bo Lv
Yi Long
Cheng Sun
Xiaobing Yang
Xia Zou
Chunbo Chen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1626-0

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